| Green Ridge Behavioral Health, Llc | |
|
1395 Piccard Dr Ste 320 Rockville MD 20850-4349 | |
| (240) 683-6202 | |
| (240) 683-6203 |
| Full Name | Green Ridge Behavioral Health, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1395 Piccard Dr Ste 320, Rockville, Maryland |
| Authorized Official Name and Position | Samina Yousufi (OWNER) |
| Authorized Official Contact | 2406836202 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Ridge Behavioral Health, Llc 1395 Piccard Dr Ste 320 Rockville MD 20850-4349 Ph: (240) 683-6202 | Green Ridge Behavioral Health, Llc 1395 Piccard Dr Ste 320 Rockville MD 20850-4349 Ph: (240) 683-6202 |
| NPI Number | 1407088339 |
|---|---|
| Provider Enumeration Date | 08/11/2009 |
| Last Update Date | 11/06/2024 |
| Certification Date | 11/06/2024 |
| Medicare PECOS PAC ID | 3476685181 |
|---|---|
| Medicare Enrollment ID | O20101130000624 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407088339 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (Maryland) | Secondary |
| 2084N0400X | Psychiatry & Neurology - Neurology | D0056459 (Maryland) | Primary |
| Provider Name | Samina Yousufi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487608196 PECOS PAC ID: 6507801511 Enrollment ID: I20050621000600 |
| Provider Name | Maria Castineira Garcia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730382599 PECOS PAC ID: 9133341928 Enrollment ID: I20141111001688 |
| Provider Name | Angela Ghersi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437494887 PECOS PAC ID: 3870835580 Enrollment ID: I20190430000494 |
| Provider Name | Momoh Makieu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376198697 PECOS PAC ID: 6204167430 Enrollment ID: I20191023000099 |
| Provider Name | Titilayo Olakiitan Afe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477261428 PECOS PAC ID: 3476919697 Enrollment ID: I20230515000149 |
| Provider Name | Sherina Maryam Shamsa |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316504848 PECOS PAC ID: 0345697009 Enrollment ID: I20231117000712 |
| Provider Name | Sophia Ugonma Atu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669119640 PECOS PAC ID: 2466894431 Enrollment ID: I20240610003713 |
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