| Tidemark Intervention Services | |
|
7822 Eastern Ave Baltimore MD 21224-2115 | |
| (443) 596-8178 | |
| Not Available |
| Full Name | Tidemark Intervention Services |
|---|---|
| Speciality | Social Worker |
| Location | 7822 Eastern Ave, Baltimore, Maryland |
| Authorized Official Name and Position | Ryne Laxton (CEO) |
| Authorized Official Contact | 4844327882 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidemark Intervention Services 7822 Eastern Ave Baltimore MD 21224-2115 Ph: (443) 596-8178 | Tidemark Intervention Services 7822 Eastern Ave Baltimore MD 21224-2115 Ph: (443) 596-8178 |
| NPI Number | 1720595242 |
|---|---|
| Provider Enumeration Date | 01/05/2018 |
| Last Update Date | 08/16/2022 |
| Certification Date | 08/16/2022 |
| Medicare PECOS PAC ID | 7911317441 |
|---|---|
| Medicare Enrollment ID | O20201111002065 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720595242 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 18885 (Maryland) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Ryne Laxton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326469206 PECOS PAC ID: 5991077885 Enrollment ID: I20170828003574 |
| Provider Name | Syeira Anthony |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093397945 PECOS PAC ID: 4183023310 Enrollment ID: I20210520001415 |
| Provider Name | Cara L Nelsen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386849743 PECOS PAC ID: 6608863766 Enrollment ID: I20220112002601 |
| Provider Name | Nicole C Collison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447860143 PECOS PAC ID: 7113310269 Enrollment ID: I20220214000189 |
| Provider Name | Kira Markoff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891424776 PECOS PAC ID: 9830575463 Enrollment ID: I20221004003444 |
| Provider Name | Amanda Mullins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134846355 PECOS PAC ID: 6709259021 Enrollment ID: I20230307000388 |
| Provider Name | Stacie Nicole Harrison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811280803 PECOS PAC ID: 5597123802 Enrollment ID: I20230620000130 |
| Provider Name | Megan L Nawrocki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558056978 PECOS PAC ID: 4789032319 Enrollment ID: I20231121000915 |
| Provider Name | Samantha Colleen Lane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578347621 PECOS PAC ID: 1052769569 Enrollment ID: I20231122000426 |
| Provider Name | Micah Saviet |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407560576 PECOS PAC ID: 3779931092 Enrollment ID: I20231128000916 |
| Provider Name | Lashea Dixon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285107284 PECOS PAC ID: 4880038587 Enrollment ID: I20240221002840 |
| Provider Name | Jillian Block |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285274712 PECOS PAC ID: 2163868563 Enrollment ID: I20240307002688 |
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