| Corsica River Mental Health Services, Inc. | |
|
120 Banjo Ln Centreville MD 21617-1002 | |
| (410) 758-2211 | |
| (410) 758-1223 |
| Full Name | Corsica River Mental Health Services, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 120 Banjo Ln, Centreville, Maryland |
| Authorized Official Name and Position | John F. Plaskon (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4107583050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Corsica River Mental Health Services, Inc. 120 Banjo Ln P.o. Box 718 Centreville MD 21617-1002 Ph: (410) 758-2211 | Corsica River Mental Health Services, Inc. 120 Banjo Ln Centreville MD 21617-1002 Ph: (410) 758-2211 |
| NPI Number | 1396077749 |
|---|---|
| Provider Enumeration Date | 02/10/2010 |
| Last Update Date | 10/25/2010 |
| Medicare PECOS PAC ID | 0941497382 |
|---|---|
| Medicare Enrollment ID | O20101210000133 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396077749 | NPI | - | NPPES |
| 419867100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Susan K Eakins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073581187 PECOS PAC ID: 0648296715 Enrollment ID: I20051018000775 |
| Provider Name | Mary E Hall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760666424 PECOS PAC ID: 4183619513 Enrollment ID: I20080424000545 |
| Provider Name | Kevin C Mcquiston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649358516 PECOS PAC ID: 2466520622 Enrollment ID: I20081110000373 |
| Provider Name | Julia R Strong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164556734 PECOS PAC ID: 5890823504 Enrollment ID: I20100526000894 |
| Provider Name | Laurence Pezor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427055946 PECOS PAC ID: 5294981072 Enrollment ID: I20120809000798 |
| Provider Name | Paula Turner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447509088 PECOS PAC ID: 9638313281 Enrollment ID: I20130920000264 |
| Provider Name | Sheri Lyn Christopher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659568780 PECOS PAC ID: 1153641287 Enrollment ID: I20150513001475 |
| Provider Name | Mary B Bourbon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023499548 PECOS PAC ID: 4688988504 Enrollment ID: I20150805007111 |
| Provider Name | Krystle Nicole Ladd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700383742 PECOS PAC ID: 3779848361 Enrollment ID: I20180601000122 |
| Provider Name | Kaye-de-ann Rattray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891240073 PECOS PAC ID: 9830475482 Enrollment ID: I20200219001125 |
| Provider Name | Brandy Dawson Cumberland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497410633 PECOS PAC ID: 7618942756 Enrollment ID: I20220126001311 |
| Provider Name | Carol M Asplen- Masden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164007373 PECOS PAC ID: 4284015553 Enrollment ID: I20220718001968 |
| Provider Name | Sara Hayden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326620832 PECOS PAC ID: 9739554544 Enrollment ID: I20230410001451 |
| Provider Name | Tyler J Corkum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285125062 PECOS PAC ID: 7113375015 Enrollment ID: I20231204001692 |
| Provider Name | Ashley Mogle |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063187961 PECOS PAC ID: 5890139349 Enrollment ID: I20240223000115 |
| Provider Name | Andrea L Minerva |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396377032 PECOS PAC ID: 7214372507 Enrollment ID: I20240227000065 |
Corsica Family Therapy, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 205 E Water St, Suite C, Centreville, MD 21617 Phone: 410-490-9742 | |
Community Behavioral Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 142 Coursevall Dr, Centreville, MD 21617 Phone: 410-758-1787 | |
Project Chesapeake, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 202 Coursevall Dr Ste 104, Centreville, MD 21617 Phone: 443-262-0425 | |
Affiliated Sante Group Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2977 4h Park Rd, Centreville, MD 21617 Phone: 410-463-4455 | |
Project Chesapeake, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 202 Coursevall Dr Ste 104, Centreville, MD 21617 Phone: 443-262-0425 | |
Bridges Behavioral Health & Wellness Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 207 N Liberty St, Suite B, Centreville, MD 21617 Phone: 410-758-8750 Fax: 410-758-8751 | |
Crossroads Community, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 120 Banjo Ln, Centreville, MD 21617 Phone: 410-758-3050 |