| Exodus Behavioral Health Llc | |
|
700 Washington Blvd Baltimore MD 21230-2350 | |
| (410) 343-4343 | |
| (240) 770-0436 |
| Full Name | Exodus Behavioral Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 700 Washington Blvd, Baltimore, Maryland |
| Authorized Official Name and Position | James Apelstein (CEO) |
| Authorized Official Contact | 6175933333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Exodus Behavioral Health Llc 700 Washington Blvd Baltimore MD 21230-2350 Ph: (410) 343-4343 | Exodus Behavioral Health Llc 700 Washington Blvd Baltimore MD 21230-2350 Ph: (410) 343-4343 |
| NPI Number | 1013535442 |
|---|---|
| Provider Enumeration Date | 07/13/2020 |
| Last Update Date | 08/12/2020 |
| Certification Date | 08/12/2020 |
| Medicare PECOS PAC ID | 9931514247 |
|---|---|
| Medicare Enrollment ID | O20210219000046 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013535442 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jeanette Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659597185 PECOS PAC ID: 0446308241 Enrollment ID: I20090505000510 |
| Provider Name | Catherine Medina |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922240118 PECOS PAC ID: 0143550848 Enrollment ID: I20190923003230 |
| Provider Name | Cecelia Carroll |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548592314 PECOS PAC ID: 6305256082 Enrollment ID: I20201109001425 |
| Provider Name | Gideon Tah Fon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891304887 PECOS PAC ID: 7810303674 Enrollment ID: I20210303001431 |
| Provider Name | Oluwatosin Arowosegbe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801487657 PECOS PAC ID: 4587060793 Enrollment ID: I20210913003602 |
| Provider Name | Hae Won H Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568931913 PECOS PAC ID: 7113268608 Enrollment ID: I20211117000647 |
| Provider Name | Nana-amma Owusu-donkor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952945867 PECOS PAC ID: 9931535481 Enrollment ID: I20211117003371 |
| Provider Name | Phylea C Daniels-mccoy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619510922 PECOS PAC ID: 0547628554 Enrollment ID: I20230623001766 |
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