NPIMap

Organization Active NPI

Ellicott City Pediatric Associates, PA

  • Mental Health Counselor
  • Ellicott City, MD
National Provider Identifier
1861119117
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
ELLICOTT CITY PEDIATRIC ASSOCIATES, PA
Practice address
9011 Chevrolet Dr Ste 1-6
Ellicott City, MD 21042-4024
Phone
(410) 465-7550
Fax
(410) 465-6359
NPI assigned
Oct 26, 2022
Last updated
Nov 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Oliver Custodio GalitaNPI 1346206489
Title
Owner
Phone
(410) 465-7550

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

9011 Chevrolet Dr Ste 1-6
Ellicott City, MD 21042-4024

Mailing address

9011 Chevrolet Dr Ste 1-6
Ellicott City, MD 21042-4024
Phone (410) 465-7550

National Provider Directory

National Provider Directory
Tax ID family
Dr Leffler Cahill Berger PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

9011 Chevrolet Dr
Ste 16
Ellicott City, MD 21042
Phone (410) 465-7550

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667865600000",
    "number": "1861119117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9011 CHEVROLET DR STE 1-6",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210424024",
            "telephone_number": "410-465-7550",
            "fax_number": "410-465-6359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9011 CHEVROLET DR STE 1-6",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210424024",
            "telephone_number": "410-465-7550",
            "fax_number": "410-465-6359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLICOTT CITY PEDIATRIC ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-26",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A",
        "authorized_official_last_name": "GALITA",
        "authorized_official_first_name": "OLIVER",
        "authorized_official_middle_name": "CUSTODIO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-465-7550"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.