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NPI Code Detail

MEDICARE: LUMINIS HEALTH BEHAVIORAL HEALTH SERVICES, LLC

MEDICARE: LUMINIS HEALTH BEHAVIORAL HEALTH SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
22084P0800XPsychiatry Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750042362
Entity Type Code : Organization
Provider Name (Legal Business Name) : LUMINIS HEALTH BEHAVIORAL HEALTH SERVICES, LLC
Provider Business Mailing Address
First Line : PO BOX 411367
Second Line :
City : BOSTON
State : MA
Zip : 02241-1367
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8200 GOOD LUCK RD
Second Line :
City : LANHAM
State : MD
Zip : 20706-3511
Country : US
Telephone Number : 301-623-4350
Fax Number : 301-623-4351
Authorized Official
Title or Position : COO
Name : PETER ODENWALD
Credential :
Telephone Number : 443-481-6415
Provider Enumeration Date : 01/05/2022
Last Update Date : 02/17/2026

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