Individual provider Active NPI

Lilian Odera, PH.D.

  • Psychologist
  • Millersville, MD
National Provider Identifier
1992054324
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
05769 Issued in MD
Practice address
8258 Veterans Hwy Ste 13-15
Millersville, MD 21108-1457
Phone
(410) 757-2077
NPI assigned
Aug 30, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY7889 FL
Psychologist 103T00000X 05769 MD Primary

Addresses

Primary practice location

8258 Veterans Hwy Ste 13-15
Millersville, MD 21108-1457

Mailing address

8258 Veterans Hwy Ste 13-15
Millersville, MD 21108-1457
Phone (410) 757-2077

Other practice location 1

7600 Red Road
129
South Miami, FL 33143
Phone (305) 608-6025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220927001069 MD Practitioner - Clinical Psychologist 7810141124 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Arundel Mental Health Professionals LCGroup PAC ID 4981688173, 118 clinicians

Practice addresses (Care Compare)

1662 Village GRN
Crofton, MD 21114-2014
Phone (410) 757-2077

2650 Quarry Lake Dr
Suite 200
Baltimore, MD 21209-3756
Phone (410) 757-2077

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
05769MDMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Arundel Mental Health Professionals L.C. Clinical CurrentSince Aug 2, 2022 Accepting new patients
Arundel Mental Health Professionals LLC Clinical PastSince Jul 31, 2022 Accepting new patients

Locations

1511 Ritchie Hwy
Ste 202
Arnold, MD 21012
Phone (410) 757-5184

2650 Quarry Lake Dr
Ste 200
Baltimore, MD 21209

1662 Village Grn
#B
Crofton, MD 21114

1662 Village Grn
Crofton, MD 21114
Phone 4107572077 ext. 8137

8258 Veterans Hwy
Ste 13
Millersville, MD 21108
Phone (410) 768-6088

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641859200000",
    "number": "1992054324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8258 VETERANS HWY STE 13-15",
            "city": "MILLERSVILLE",
            "state": "MD",
            "postal_code": "211081457",
            "telephone_number": "410-757-2077",
            "fax_number": "443-782-2342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8258 VETERANS HWY STE 13-15",
            "city": "MILLERSVILLE",
            "state": "MD",
            "postal_code": "211081457",
            "telephone_number": "410-757-2077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7600 Red Road",
            "address_2": "129",
            "address_purpose": "LOCATION",
            "city": "South Miami",
            "state": "FL",
            "postal_code": "33143",
            "country_code": "US",
            "telephone_number": "305-608-6025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODERA",
        "first_name": "LILIAN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-30",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY7889",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MD",
            "license": "05769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Millersville, MD

Sources for this page

Verify at the official NPI Registry.