Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Blue Moon Behavioral Health, PLLC

Organization Psychiatric/Mental Health Nurse Practitioner · NPI 1023841061

Blue Moon Behavioral Health, PLLC is a Psychiatric/Mental Health Nurse Practitioner in Rockville, Maryland. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

199 E Montgomery Ave Ste 100
Rockville, MD 20850-2361
Phone: (301) 719-2913
Fax: (301) 867-5278
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X

Record details

NPI number1023841061
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Shineka Mack — Owner · (704) 258-6720
NPI enumeratedAugust 23, 2024
Last updated in NPPESAugust 23, 2024
Certification dateAugust 23, 2024
Mailing address9302 Wooden Rd, Raleigh, NC 27617-8214

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