| Eastern Shore Psychological Services Llc | |
|
29520 Canvasback Dr Easton MD 21601-7124 | |
| (410) 822-5007 | |
| (410) 822-5569 |
| Full Name | Eastern Shore Psychological Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 29520 Canvasback Dr, Easton, Maryland |
| Authorized Official Name and Position | Mary Kathryn Seifert (EXECUTIVE DIRECTOR CEO) |
| Authorized Official Contact | 4103346961 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastern Shore Psychological Services Llc 1113 Healthway Drive Salisbury MD 21804-4470 Ph: (410) 334-6961 | Eastern Shore Psychological Services Llc 29520 Canvasback Dr Easton MD 21601-7124 Ph: (410) 822-5007 |
| NPI Number | 1881781508 |
|---|---|
| Provider Enumeration Date | 10/06/2006 |
| Last Update Date | 08/28/2017 |
| Medicare PECOS PAC ID | 5294729950 |
|---|---|
| Medicare Enrollment ID | O20040414000564 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881781508 | NPI | - | NPPES |
| 346646 | Other | MD | MHN |
| 609500301 | Medicaid | MD | |
| 1659630523 | Medicaid | MD | |
| 259147000 | Other | MD | MAGELLAN |
| 517251 | Other | UHC MAMSI | |
| 1386717189 | Medicaid | MD | |
| 520202701 | Medicaid | MD | |
| LM49EA | Other | MD | BCBS GROUP |
| 609550002 | Medicaid | MD | |
| R968 | Other | CAREFIRST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Karen A Siegman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912923954 PECOS PAC ID: 5799731915 Enrollment ID: I20050330000590 |
| Provider Name | Kathey J Larger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558376400 PECOS PAC ID: 8729087622 Enrollment ID: I20061202000181 |
| Provider Name | Mary D Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306051313 PECOS PAC ID: 2264580968 Enrollment ID: I20090507000444 |
| Provider Name | Paul M Katz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629047154 PECOS PAC ID: 0143356618 Enrollment ID: I20100414000066 |
| Provider Name | Kelly Hawkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235245044 PECOS PAC ID: 5193852416 Enrollment ID: I20100419000451 |
| Provider Name | Barbara K Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669584314 PECOS PAC ID: 4284671900 Enrollment ID: I20100805000422 |
| Provider Name | Wala Neh A Labala |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396832010 PECOS PAC ID: 9032242375 Enrollment ID: I20100806000258 |
| Provider Name | Paul J Washo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003043563 PECOS PAC ID: 7719002054 Enrollment ID: I20100910000167 |
| Provider Name | Laura F Harrison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982782397 PECOS PAC ID: 8123210903 Enrollment ID: I20101012000706 |
| Provider Name | Constance W Pullen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790872513 PECOS PAC ID: 8426240045 Enrollment ID: I20101014000048 |
| Provider Name | Mary K Seifert |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164510178 PECOS PAC ID: 9931194230 Enrollment ID: I20101022000941 |
| Provider Name | Dana L Demaso |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497973036 PECOS PAC ID: 3971798075 Enrollment ID: I20101115001145 |
| Provider Name | Laurence J Pezor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427055946 PECOS PAC ID: 5294981072 Enrollment ID: I20120809000798 |
| Provider Name | Sandra A Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245586122 PECOS PAC ID: 1557511060 Enrollment ID: I20121018000312 |
| Provider Name | Ralph S Wolf |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396764932 PECOS PAC ID: 9133018716 Enrollment ID: I20121112000518 |
| Provider Name | Saima Maqsood |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629276985 PECOS PAC ID: 5395984074 Enrollment ID: I20130611000279 |
| Provider Name | Ovais Khalid |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033345954 PECOS PAC ID: 1153560578 Enrollment ID: I20130617000016 |
| Provider Name | Wendy L Holder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124115811 PECOS PAC ID: 5496724254 Enrollment ID: I20131213000216 |
| Provider Name | Deborah E Hyle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760643217 PECOS PAC ID: 4082842752 Enrollment ID: I20140103000039 |
| Provider Name | Elizabeth Schafer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891085304 PECOS PAC ID: 1052534724 Enrollment ID: I20140527001622 |
| Provider Name | Amy Nicholson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306257316 PECOS PAC ID: 2567680457 Enrollment ID: I20140908000928 |
| Provider Name | Valerie Jane Getsinger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174829907 PECOS PAC ID: 7517285828 Enrollment ID: I20150417000327 |
| Provider Name | Venessa Ann Bowers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164720124 PECOS PAC ID: 6305074907 Enrollment ID: I20150513001176 |
| Provider Name | Deborah Lynn Daringer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538566849 PECOS PAC ID: 5799093225 Enrollment ID: I20151002002153 |
| Provider Name | Adriane Taylor Chilcoate |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174958680 PECOS PAC ID: 1658671359 Enrollment ID: I20151202001914 |
| Provider Name | Stephanie Kay Dudley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235487059 PECOS PAC ID: 5294037594 Enrollment ID: I20160104001241 |
| Provider Name | Megan Czyz Pryor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447663976 PECOS PAC ID: 4284937798 Enrollment ID: I20160115001592 |
| Provider Name | Mehryar Tabib |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295776698 PECOS PAC ID: 9931196953 Enrollment ID: I20160128002548 |
| Provider Name | Anne Rachel Hoffman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255452322 PECOS PAC ID: 9931499647 Enrollment ID: I20160609000308 |
| Provider Name | James O'neil Siegman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033540406 PECOS PAC ID: 7810285855 Enrollment ID: I20161007000283 |
| Provider Name | Shanez Theresa Jenkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518247899 PECOS PAC ID: 8820386717 Enrollment ID: I20161010000150 |
| Provider Name | Eboni D Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952737454 PECOS PAC ID: 0840571436 Enrollment ID: I20161219001493 |
| Provider Name | Randall Bruce Minteer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962809889 PECOS PAC ID: 1355618331 Enrollment ID: I20170523000207 |
| Provider Name | Jeffrey Byrne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033571534 PECOS PAC ID: 3375809478 Enrollment ID: I20171106001929 |
| Provider Name | Reginald Shockley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619046919 PECOS PAC ID: 4082962766 Enrollment ID: I20180813002779 |
| Provider Name | Mark A Shaffer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659314565 PECOS PAC ID: 8820194053 Enrollment ID: I20181214000428 |
| Provider Name | Lauren Renee Labe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124648936 PECOS PAC ID: 6002232972 Enrollment ID: I20200824000179 |
| Provider Name | Aisha Hassan Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053951004 PECOS PAC ID: 9638585557 Enrollment ID: I20210301001712 |
| Provider Name | Whitney Bradshaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104454701 PECOS PAC ID: 9931516705 Enrollment ID: I20210323000050 |
| Provider Name | Amanda Marie Frey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851890479 PECOS PAC ID: 2062817158 Enrollment ID: I20210827001641 |
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