Active NPI
Lamaurice H Gardner, PSYD
- Clinical Psychologist
- Southfield, MI
National Provider Identifier
1013945229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301007265
- Practice address
- 22250 Providence Dr
Suite 207
Southfield, MI 48075-4825 - Phone
- (313) 576-1000
- NPI assigned
- Jun 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301007265 | MI | Primary |
Addresses
Primary practice location
22250 Providence Dr
Suite 207
Southfield, MI 48075-4825
Mailing address
22250 Providence Dr
Suite 207
Southfield, MI 48075-4825
Phone (313) 576-1000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 680F34976 | Other | MI | BLUE CROSS MICHIGAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301007265 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013945229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22250 PROVIDENCE DR",
"address_2": "SUITE 207",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480754825",
"telephone_number": "313-576-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22250 PROVIDENCE DR",
"address_2": "SUITE 207",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480754825",
"telephone_number": "313-576-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "LAMAURICE",
"middle_name": "H",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301007265",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS MICHIGAN",
"identifier": "680F34976",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.