Release and Renew Mental Wellness Clinic

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

RELEASE AND RENEW MENTAL WELLNESS CLINIC

Practice address

1301 York Rd Ste 800
Lutherville Timonium, MD 21093-6011

Phone

(410) 376-8728

Fax

(410) 862-3774

NPI assigned

Jan 5, 2023

Organization subpart

No

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

Authorized official

Name

Mrs. Tamara Pottillo, APRN-PMHNPI 1922717495

Title

Owner

Phone

(443) 745-8620

Specialties & licenses 3

Addresses

Other names 1

• Release and Renew Mental Wellness Former legal business name

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tamara Boyd Pottillo

  • Psychiatric/Mental Health Nurse Practitioner
  • Lutherville Timonium, MD
  • NPI 1922717495
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1672876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721347200000",
    "number": "1972216869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 YORK RD STE 800",
            "city": "LUTHERVILLE TIMONIUM",
            "state": "MD",
            "postal_code": "210936011",
            "telephone_number": "410-376-8728",
            "fax_number": "410-862-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 YORK RD STE 800",
            "city": "LUTHERVILLE TIMONIUM",
            "state": "MD",
            "postal_code": "210936011",
            "telephone_number": "410-376-8728",
            "fax_number": "410-862-3774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RELEASE AND RENEW MENTAL WELLNESS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-05",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A",
        "authorized_official_last_name": "POTTILLO",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-745-8620",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN-PMH"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Release and Renew Mental Wellness",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Jennifer Raia, LCSW-C, MSW
• Heather A. Raley, L.C.P.C
• Manjula Ramachandran
• Blake Reddick
• Douglas David Reh, M.D.
• Rebecca Riley Olin, LCPC, MT-BC
• Chloe Ring, MS
• Premila Roberts, REGISTERED NURSE
• Jessica Robinson
• Rocket Doctor Practice Group, P.C.

• Psychiatric/Mental Health Nurse Practitioner in Lutherville Timonium, MD
• Providers in Lutherville Timonium, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; 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.