Active NPI
Shore Neurocognitive Health LLC
- Clinical Social Worker
- Easton, MD
National Provider Identifier
1972043750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 13193
- 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
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Elizabeth Jane Parker-O'Brien, MSW
- Title
- Owner
- Phone
- (410) 443-1039
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170418000235 | MD | Part B Supplier - Clinic/Group Practice | 0749566214 |
Receives reassigned benefits from 5 practitioners Practice locations: Easton, MD |
National Provider Directory
National Provider DirectoryLocations
29466 Pintail Dr
Ste 9
Easton, MD 21601
Phone (410) 770-5140
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Psychiatric/Mental Health Nurse Practitioner
- Denton, MD
- NPI 1235578261
MD
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.