| Carroll County Youth Service Bureau, Inc. | |
|
59 Kate Wagner Rd. Westminster MD 21157 | |
| (410) 848-2500 | |
| (410) 876-3016 |
| Full Name | Carroll County Youth Service Bureau, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 59 Kate Wagner Rd., Westminster, Maryland |
| Authorized Official Name and Position | Lynn Davis (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4432448649 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carroll County Youth Service Bureau, Inc. 59 Kate Wagner Rd Westminster MD 21157-6957 Ph: (410) 848-2500 | Carroll County Youth Service Bureau, Inc. 59 Kate Wagner Rd. Westminster MD 21157 Ph: (410) 848-2500 |
| NPI Number | 1710042924 |
|---|---|
| Provider Enumeration Date | 12/27/2006 |
| Last Update Date | 02/15/2023 |
| Certification Date | 02/15/2023 |
| Medicare PECOS PAC ID | 2365417052 |
|---|---|
| Medicare Enrollment ID | O20040826001093 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710042924 | NPI | - | NPPES |
| 615501400 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 12225 (Maryland) | Primary |
| Provider Name | Angela E Chmar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912063843 PECOS PAC ID: 6103950910 Enrollment ID: I20100816000839 |
| Provider Name | Damian Ayichi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790111532 PECOS PAC ID: 0648409417 Enrollment ID: I20140128001005 |
| Provider Name | Janna S Cleary |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982039301 PECOS PAC ID: 3072744507 Enrollment ID: I20140327000092 |
| Provider Name | Tiffany Nichole Ellison Masimore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346421716 PECOS PAC ID: 5193049278 Enrollment ID: I20150120001578 |
| Provider Name | Sandy Denise Hansborough |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609164631 PECOS PAC ID: 2466733985 Enrollment ID: I20161221000870 |
| Provider Name | Carla E Trump |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841317898 PECOS PAC ID: 3072868553 Enrollment ID: I20180625002650 |
| Provider Name | Phoebe Antoinette Underwood-davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457844722 PECOS PAC ID: 6800148123 Enrollment ID: I20181015000317 |
| Provider Name | Karisa E Nastos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477102127 PECOS PAC ID: 6800263971 Enrollment ID: I20221102000463 |
| Provider Name | Hollie E Cushen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427613082 PECOS PAC ID: 9436520236 Enrollment ID: I20230113000126 |
| Provider Name | Robin G Harlan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588853220 PECOS PAC ID: 7517497209 Enrollment ID: I20250211001285 |
| Provider Name | Abbey Mcalister |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1619600632 PECOS PAC ID: 7517488760 Enrollment ID: I20250305000444 |
| Provider Name | Dana Kemp |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184280471 PECOS PAC ID: 3678094745 Enrollment ID: I20250305001705 |
| Provider Name | Rosalind Esteves |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225506785 PECOS PAC ID: 9335660414 Enrollment ID: I20250305001911 |
| Provider Name | Robert Jarrett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053684902 PECOS PAC ID: 9931620069 Enrollment ID: I20250305003342 |
| Provider Name | Kate A Swisher Lee |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972845105 PECOS PAC ID: 7214458157 Enrollment ID: I20250307000090 |
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