Mary Deitch, JD, PSY.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS016151 Issued in PA

Practice address

1112 Macdade Blvd
Woodlyn, PA 19094-1322

Phone

(610) 945-8021

NPI assigned

Dec 1, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Growth and Recovery Center Inc.Group PAC ID 7214074681, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Juris Doctor

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Growth and Recovery Center Inc.

  • Community/Behavioral Health Agency
  • Lafayette Hill, PA
  • NPI 1275764524
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1448928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448928000000",
    "number": "1073987186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 MACDADE BLVD",
            "city": "WOODLYN",
            "state": "PA",
            "postal_code": "190941322",
            "telephone_number": "610-945-8021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 MACDADE BLVD",
            "city": "WOODLYN",
            "state": "PA",
            "postal_code": "190941322",
            "telephone_number": "610-945-8021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEITCH",
        "first_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "JD, PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-01",
        "last_updated": "2015-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS016151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Omar Emmens, LPN
• Godlove Ebong Etape, RPH
• Rachel Marie Garber

• Psychologist in Woodlyn, PA
• Providers in Woodlyn, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.