Healthcare Provider Details

I. General information

NPI: 1427476316
Provider Name (Legal Business Name): MARIA MOCK B.S., QMHS, ORC, PRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA L FARMER B.S., QMHS, ORC, PRS

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date: 09/03/2024
Reactivation Date: 11/20/2025

III. Provider practice location address

7463 OLD RIVER DR
BLACKLICK OH
43004-7126
US

IV. Provider business mailing address

7463 OLD RIVER DR
BLACKLICK OH
43004-7126
US

V. Phone/Fax

Practice location:
  • Phone: 614-668-9338
  • Fax:
Mailing address:
  • Phone: 614-668-9338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.005841
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: