Active NPI
Michelle F Pereira, PSY.D.
- Clinical Psychologist
- Germantown, MD
National Provider Identifier
1104304740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 06114
- Practice address
- 19733 Executive Park Cir
Germantown, MD 20874-2642 - Phone
- (301) 515-8142
- NPI assigned
- Aug 6, 2018
- Sex
- Female
- 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 | 06114 | MD | Primary |
Addresses
Primary practice location
19733 Executive Park Cir
Germantown, MD 20874-2642
Mailing address
1719 Wheyfield Dr
Frederick, MD 21701-9337
Phone (301) 919-5122
Other practice location 1
60 Market St Ste 207
Gaithersburg, MD 20878-6559
Phone (240) 750-6467
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06114 | MD | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oasis the Mental Health Center, LLC | Past | Accepting new patients | |
| Quince Orchard Psychotherapy LLC | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Psychiatry Physician
- Glen Burnie, MD
- NPI 1174606057
-
- Clinical Social Worker
- Nottingham, MD
- NPI 1619895844
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533513600000",
"number": "1104304740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1719 WHEYFIELD DR",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217019337",
"telephone_number": "301-919-5122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19733 EXECUTIVE PARK CIR",
"city": "GERMANTOWN",
"state": "MD",
"postal_code": "208742642",
"telephone_number": "301-515-8142"
}
],
"practiceLocations": [
{
"address_1": "60 Market St Ste 207",
"address_purpose": "LOCATION",
"city": "Gaithersburg",
"state": "MD",
"postal_code": "208786559",
"country_code": "US",
"telephone_number": "240-750-6467",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PEREIRA",
"first_name": "MICHELLE",
"middle_name": "F",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-06",
"last_updated": "2018-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "06114",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Germantown, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2018; 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.