Provider Demographics
NPI:1881781508
Name:EASTERN SHORE PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:EASTERN SHORE PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:SEIFERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-334-6961
Mailing Address - Street 1:1113 HEALTHWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-4470
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6362
Practice Address - Street 1:29520 CANVASBACK DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7124
Practice Address - Country:US
Practice Address - Phone:410-822-5007
Practice Address - Fax:410-822-5569
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN SHORE PSYCHOLOGICAL SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD346646OtherMHN
MD609500301Medicaid
MD1659630523Medicaid
MD259147000OtherMAGELLAN
517251OtherUHC MAMSI
MD1386717189Medicaid
MD520202701Medicaid
MDLM49EAOtherBCBS GROUP
MD609550002Medicaid
R968OtherCAREFIRST
MD520202701Medicaid