| Bodhi | |
|
2327 Pulaski Hwy Suite 101b North East MD 21901-3706 | |
| (443) 877-4044 | |
| (443) 505-7065 |
| Full Name | Bodhi |
|---|---|
| Speciality | Counselor |
| Location | 2327 Pulaski Hwy, North East, Maryland |
| Authorized Official Name and Position | Janice Fairchild (OWNER) |
| Authorized Official Contact | 4104560142 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bodhi 2327 Pulaski Hwy Suite 101b North East MD 21901-3706 Ph: (443) 877-4044 | Bodhi 2327 Pulaski Hwy Suite 101b North East MD 21901-3706 Ph: (443) 877-4044 |
| NPI Number | 1467724013 |
|---|---|
| Provider Enumeration Date | 01/29/2012 |
| Last Update Date | 01/29/2012 |
| Medicare PECOS PAC ID | 7719204460 |
|---|---|
| Medicare Enrollment ID | O20150318000988 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467724013 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LC2857 (Maryland) | Primary |
| Provider Name | Brittany E Nair |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619986486 PECOS PAC ID: 7719988856 Enrollment ID: I20070116000527 |
| Provider Name | Elizabeth O'hara |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871643106 PECOS PAC ID: 9234378811 Enrollment ID: I20130611000360 |
| Provider Name | Shana L Moorefield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598287450 PECOS PAC ID: 4981970225 Enrollment ID: I20171101000213 |
| Provider Name | Frances Horzempa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023665577 PECOS PAC ID: 4688905342 Enrollment ID: I20191010000347 |
| Provider Name | Autumn Rufener |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043608136 PECOS PAC ID: 4284027038 Enrollment ID: I20220131001957 |
| Provider Name | Shauna Leanne Mcgough |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801286596 PECOS PAC ID: 6608261458 Enrollment ID: I20220315001083 |
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