| Lifespan Behavioral Health Services Pc | |
|
1003 W 7th St Ste 200 Frederick MD 21701-4106 | |
| (301) 245-6300 | |
| Not Available |
| Full Name | Lifespan Behavioral Health Services Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1003 W 7th St Ste 200, Frederick, Maryland |
| Authorized Official Name and Position | Carolyn Reidy (OFFICE ADMIN) |
| Authorized Official Contact | 8008197570 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifespan Behavioral Health Services Pc 2705 Silver Hammer Way Brookeville MD 20833-3244 Ph: () - | Lifespan Behavioral Health Services Pc 1003 W 7th St Ste 200 Frederick MD 21701-4106 Ph: (301) 245-6300 |
| NPI Number | 1427677061 |
|---|---|
| Provider Enumeration Date | 04/14/2020 |
| Last Update Date | 04/14/2020 |
| Certification Date | 04/14/2020 |
| Medicare PECOS PAC ID | 4082041637 |
|---|---|
| Medicare Enrollment ID | O20200221000259 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427677061 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Lynn Sorbello |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851306245 PECOS PAC ID: 7810960606 Enrollment ID: I20040819000095 |
| Provider Name | Larry S Harper |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881620789 PECOS PAC ID: 3476526260 Enrollment ID: I20100924000405 |
| Provider Name | Lynda L Artusio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841363702 PECOS PAC ID: 2668453440 Enrollment ID: I20150720000639 |
| Provider Name | Evan N Dickstein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942688379 PECOS PAC ID: 2668773474 Enrollment ID: I20151221002534 |
| Provider Name | Joshua B Sussal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922212174 PECOS PAC ID: 6204936446 Enrollment ID: I20160309000367 |
| Provider Name | Amy D Hedderman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689953994 PECOS PAC ID: 1759680028 Enrollment ID: I20160601000320 |
| Provider Name | Geoffrey G Grammer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528141017 PECOS PAC ID: 8426375825 Enrollment ID: I20161115000083 |
| Provider Name | Christopher Brian Carpenter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578095444 PECOS PAC ID: 3476822180 Enrollment ID: I20170711002857 |
| Provider Name | Stephen E Simon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174722102 PECOS PAC ID: 5496015000 Enrollment ID: I20180829000974 |
| Provider Name | Maria C Hammill |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1235178054 PECOS PAC ID: 8123012689 Enrollment ID: I20180912000272 |
| Provider Name | Christopher Wheatley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063969806 PECOS PAC ID: 8628353851 Enrollment ID: I20190122001833 |
| Provider Name | Millicent Boa Amponsem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659858769 PECOS PAC ID: 1658615570 Enrollment ID: I20201104003149 |
| Provider Name | Nicholas S Kopp |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720097132 PECOS PAC ID: 2961762604 Enrollment ID: I20210126000202 |
| Provider Name | Anna Gabriszeski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417544727 PECOS PAC ID: 9133536618 Enrollment ID: I20210330000298 |
| Provider Name | Cara Cole |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851528848 PECOS PAC ID: 6608178884 Enrollment ID: I20210412000286 |
| Provider Name | Andrea C Mazzarino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538649397 PECOS PAC ID: 8527477751 Enrollment ID: I20210510001434 |
| Provider Name | John Dahunsi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386378735 PECOS PAC ID: 3779951900 Enrollment ID: I20221119000503 |
| Provider Name | Shamara Quinonez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821672171 PECOS PAC ID: 2163879263 Enrollment ID: I20231110002768 |
| Provider Name | Linda Campbell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871520627 PECOS PAC ID: 9638526122 Enrollment ID: I20231117002939 |
| Provider Name | Christina L Poff-long |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851828826 PECOS PAC ID: 5597113233 Enrollment ID: I20231130003752 |
| Provider Name | Danielle Audley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659961688 PECOS PAC ID: 0244680353 Enrollment ID: I20240102000439 |
| Provider Name | Delaney Rubenstein |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497339592 PECOS PAC ID: 0446601090 Enrollment ID: I20240108004235 |
| Provider Name | Isabelle Hope Rohloff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013615830 PECOS PAC ID: 6608228556 Enrollment ID: I20240117000668 |
| Provider Name | Amy Zawatsky |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316284755 PECOS PAC ID: 8820445422 Enrollment ID: I20240122003063 |
| Provider Name | Laura E Teeple |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427667294 PECOS PAC ID: 5294170247 Enrollment ID: I20240229001226 |
| Provider Name | Christine Woodcock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790437150 PECOS PAC ID: 6608214739 Enrollment ID: I20240409000730 |
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