NPIMap

Organization Active NPI

Shore Neurocognitive Health LLC

  • Clinical Social Worker
  • Easton, MD
National Provider Identifier
1972043750
Registry record updated Feb 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
13193 Issued in MD
Legal business name
SHORE NEUROCOGNITIVE HEALTH LLC
Practice address
7656 Woodland Dr
Easton, MD 21601-8140
Phone
(410) 443-1039
NPI assigned
Feb 28, 2017
Last updated
Feb 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2017

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

Authorized official

Name
Elizabeth Jane Parker-O'Brien, MSWNPI 1679558910
Title
Owner
Phone
(410) 443-1039

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 13193 MD Primary

Addresses

Primary practice location

7656 Woodland Dr
Easton, MD 21601-8140

Mailing address

7656 Woodland Dr
Easton, MD 21601-8140
Phone (410) 443-1039

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170418000235 MD Part B Supplier - Clinic/Group Practice 0749566214 Receives reassigned benefits from 5 practitioners
Practice locations: Easton, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1488240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488240000000",
    "number": "1972043750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7656 WOODLAND DR",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216018140",
            "telephone_number": "410-443-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7656 WOODLAND DR",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216018140",
            "telephone_number": "410-443-1039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE NEUROCOGNITIVE HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-28",
        "last_updated": "2017-02-28",
        "status": "A",
        "authorized_official_last_name": "PARKER-O'BRIEN",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-443-1039",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "13193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Easton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.