How to Start a Therapy Private Practice in Maryland

Separate independent clinical practice from business ownership

Start with the exact credential and restrictions on the Board’s record. Maryland LCSW-C is the independent clinical social-work license; LCSW, LMSW and LBSW have different authority. Approval for nonclinical independence does not authorize psychotherapy. The rules permit LCSWs and LMSWs to be employed in private practice under LCSW-C supervision. That employment pathway is not blanket permission to establish an independent psychotherapy practice. Review the actual ownership, employment and clinical-control arrangement rather than relying on an LLC filing or a contractor label.

Arrange supervision before hiring or opening a calendar

Match the supervisor’s profession, approval and competence to the supervisee’s credential. Complete the required supervision agreement and client disclosures before services begin, and plan emergency coverage and record review. Graduate counseling and MFT rules prohibit an employee from supervising their own employer. For CAC-AD, CSC-AD and ADT roles, verify the required licensed or certified agency employment; simply hiring an LCADC does not turn an ordinary group into that agency. Obtain payer confirmation separately before budgeting for supervised clinicians’ insurance revenue.

Keep disclosures current with the October 2026 social-work rules

The October 12, 2026 amendments clarify independent clinical practice and expressly include pro bono psychotherapy in the private-practice definition. Providing services without charge does not remove license or supervision requirements. LBSWs and LMSWs without independent-practice status must give clients their supervisor’s name and contact information. Use the current rules and Board record when preparing consent forms and professional biographies.

Check limited and legacy credentials individually

Legacy certificates and temporary authorizations do not all have the same scope. Psychology training exceptions are tied to qualifying supervised education, and temporary Board authority has specific conditions and an expiration. Do not keep treating under a student exception after the qualifying program ends. Verify the credential that is currently issued, the permitted setting and the payer’s recognition before promising a service or participation date.

Business entity options

Choose the legal structure with Maryland counsel based on the owners, professions and services. Maryland permits LLCs to provide professional services while preserving licensing-board authority; do not assume every therapist must form a PLLC or that entity acceptance settles clinical ownership and supervision. Use Maryland Business Express and SDAT to check name availability, register the chosen entity when required and address a separate trade name. Confirm the principal-office address, resident agent, zoning, occupancy and any local requirements before committing to premises. Calendar annual reports and applicable business personal-property returns. Keep the legal and public names, EIN, W-9, NPI, bank account and payer records consistent. Internet advertising by Title 17 counselors and therapists must identify the practitioner’s name, credentials and certificate or license number. Follow the statutory professional-disclosure-statement requirements before charging for services, including the applicable private-practice fee schedule. A practice brand should accurately identify the clinicians who provide care. Review separate program licensing before expanding into an agency or specialized treatment program.

State and tax registration

Set federal and Maryland tax treatment with an accountant and obtain an EIN when required. SDAT registration, a federal EIN and a Comptroller tax account serve different purposes. Use the Combined Registration Application and Maryland Tax Connect for the state accounts the practice actually needs, including employer withholding when applicable. Assess income and estimated taxes, taxable purchases and any ancillary products or services rather than treating the business as broadly tax exempt. Before hiring, address unemployment insurance, workers’ compensation, wage reporting and worker classification; a 1099 agreement does not settle legal employment status or override a board’s employment requirement. Maryland FAMLI contributions begin January 1, 2027, and benefits begin January 1, 2028. Employers with Maryland employees should plan registration, reporting and contributions or an approved private-plan arrangement using current Department of Labor guidance.

Telehealth notes

Verify the client’s and clinician’s physical locations and practice authority in the relevant jurisdictions. For live sessions, confirm identity, the client’s location, a backup contact method and who else is present. Document informed consent, privacy safeguards, local emergency resources and a connection-failure plan. Follow the clinician’s own board rules: psychology requires written telepsychology consent and an initial in-person assessment unless the reason for not doing it is documented. Do not generalize one profession’s modality rules to all clinicians. As of October 20, 2026, Maryland is not listed as operational for Counseling Compact privileges, and Social Work Compact multistate licenses are not yet being issued. Compact enactment alone is not permission to practice across state lines. Maryland participates in PSYPACT; eligible psychologists need an E.Passport and an issued Authority to Practice Interjurisdictional Telepsychology, or APIT, and must be physically in their declared home state while using that authority. Associate registration does not confer it. Confirm payer coverage for the actual modality, service, location, code, modifier and authorization requirement. Telehealth authority does not establish insurance participation or guarantee payment for video, audio-only or group visits.

Mandated reporting notes

A health practitioner acting professionally who has reason to believe a child has suffered abuse or neglect must report without waiting for proof. For suspected maltreatment occurring in Maryland, make the oral report immediately to the local department of social services or appropriate law enforcement where it occurred. Send the written report to that local department with a copy to the local State’s Attorney within 48 hours of the contact or event that disclosed the concern. The written-report clock does not start with the oral report. Report suspected maltreatment outside Maryland to any Maryland local department; do not assume an adult’s disclosure of childhood abuse is exempt. Required institutional notification is additional to reporting. For a vulnerable adult, report suspected abuse, neglect, self-neglect or exploitation meeting the statutory threshold to local Adult Protective Services as soon as possible. Vulnerability depends on impaired capacity to meet daily needs, not age alone. Chapter 652, effective October 1, 2026, updates adult-protection definitions and authorizes online reporting; use an established agency route rather than assuming a new portal is operational. The child rule’s separate 48-hour written follow-up does not apply to adult reports. Maryland DHS provides the statewide child and adult reporting number 1-800-917-7383. Use 911 for immediate danger. Record the concern, recipient, time and confirmation in the appropriate record.

Insurance credentialing notes

Maryland Medicaid moved enrollment to MPRIME on October 13, 2026; older pages still referring to ePREP may lag the current instructions. Select the correct individual billing, rendering-provider and organizational arrangement, maintain the appropriate SDAT registration in good standing, and establish required group affiliations and locations. PT 36-27 explains transition rules, including possible backdating for qualifying complete, processable applications submitted by December 31, 2026. Backdating is not automatic, and claims cannot be paid before enrollment approval. For specialty behavioral health, Carelon Behavioral Health is Maryland’s Public Behavioral Health System administrative services organization. Covered specialty services are carved out of HealthChoice managed care, including for members with an MCO card; HealthChoice MCOs retain primary behavioral-health responsibilities within their arrangements. Verify the service and benefit before choosing a claim destination, and complete both Medicaid enrollment and applicable Carelon registration. Carelon’s PBHS manual distinguishes eligible independently licensed practitioners from supervised clinicians. Nonindependently licensed clinicians cannot individually enroll or be paid for services in an ordinary individual or group private practice under that pathway, and a supervisor cannot bill those services as their own. Agency and outpatient mental-health-center rules are separate. A regional moratorium on specified rehabilitation, health-home, PHP and IOP programs does not bar ordinary individual practitioners; check the current provider-type and county restrictions if developing a program. Commercial rules differ: CareFirst, for example, accepts applications for certain supervised credentials through its formal process with a qualified supervisor. That process does not override Maryland board rules or guarantee acceptance. Prepare the license, liability coverage, NPI, W-9, locations and required CAQH information, then confirm the exact network, product, individual and group affiliations, contract and effective date. Licensure, supervision, enrollment, credentialing and contracts are distinct requirements. Medical necessity concerns the particular service; payment also depends on eligibility, benefits, authorization, documentation and claim rules. A co-signature, NPI, completed CAQH profile or authorization alone does not establish billing permission or guarantee reimbursement.