Individual Provider

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

ISW10093 Issued in FL

Legal business name

INDIVIDUAL PROVIDER

Practice address

650 Palermo Vista CT
Longwood, FL 32750-3419

Phone

(317) 697-8932

NPI assigned

Sep 10, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Christine Marie Garry

Title

Master'S Level Contract Clinician

Phone

(317) 697-8932

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441843200000",
    "number": "1033587795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 PALERMO VISTA CT",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327503419",
            "telephone_number": "317-697-8932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 PALERMO VISTA CT",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327503419",
            "telephone_number": "317-697-8932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIVIDUAL PROVIDER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-10",
        "last_updated": "2015-09-10",
        "status": "A",
        "authorized_official_last_name": "GARRY",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MASTER'S LEVEL CONTRACT CLINICIAN",
        "authorized_official_telephone_number": "317-697-8932",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "ISW10093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.