NPIMap

Organization Active NPI

Lifemark Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Salisbury, MD
National Provider Identifier
1982040077
Registry record updated Mar 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
LIFEMARK INC.
Practice address
1342 S Division St Ste 401
Salisbury, MD 21804-6921
Phone
(443) 859-8584
Fax
(443) 859-8496
NPI assigned
May 15, 2013
Last updated
Mar 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2023

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

Authorized official

Name
Mr. Marion Travers, LCPCNPI 1447526546
Title
Ceo/Clinical Director
Phone
(443) 859-8584

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 7

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Multi-Specialty Clinic/Center 261QM1300X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Addiction (Substance Use Disorder) Counselor 101YA0400X
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

1342 S Division St Ste 401
Salisbury, MD 21804-6921

Mailing address

1342 S Division St Ste 401
Salisbury, MD 21804-6921
Phone (443) 859-8584

Other practice location 1

24545 Shortly Rd
Georgetown, DE 19947-4912
Phone (443) 859-8584

Other identifiers 2

IdentifierTypeStateIssuer
068375200MedicaidMD
053972400MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150803000165 MD Part B Supplier - Clinic/Group Practice 1153635396 Receives reassigned benefits from 11 practitioners
Practice locations: Salisbury, MD
O20250320000047 DE Part B Supplier - Clinic/Group Practice 1153635396 Receives reassigned benefits from 3 practitioners
Practice locations: Georgetown, DE

National Provider Directory

National Provider Directory
Tax ID family
Lifemark Inc2 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

24545 Shortly Rd
Georgetown, DE 19947
Phone (443) 859-8584

116 W Main St
Ste 204
Salisbury, MD 21801
Phone (443) 859-8584

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1368576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678838400000",
    "number": "1982040077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1342 S DIVISION ST STE 401",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218046921",
            "telephone_number": "443-859-8584",
            "fax_number": "443-859-8496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1342 S DIVISION ST STE 401",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218046921",
            "telephone_number": "443-859-8584",
            "fax_number": "443-859-8496"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24545 Shortly Rd",
            "address_purpose": "LOCATION",
            "city": "Georgetown",
            "state": "DE",
            "postal_code": "199474912",
            "country_code": "US",
            "telephone_number": "443-859-8584",
            "fax_number": "443-859-8496",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFEMARK INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-15",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A",
        "authorized_official_last_name": "TRAVERS",
        "authorized_official_first_name": "MARION",
        "authorized_official_title_or_position": "CEO/CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "443-859-8584",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "068375200",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "053972400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salisbury, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; 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.