Active NPI
Marianne Goergen, PSY.D.
- Clinical Psychologist
- Grand Blanc, MI
National Provider Identifier
1104967405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1606356
- Practice address
- 8435 Holly Rd
Grand Blanc, MI 48439-1812 - Phone
- (810) 424-2400
- Fax
- (810) 579-7222
- NPI assigned
- Feb 9, 2007
- 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 | 1606356 | MI | Primary |
Addresses
Primary practice location
8435 Holly Rd
Grand Blanc, MI 48439-1812
Mailing address
3495 S Center Rd
Burton, MI 48519-1455
Phone (810) 424-2011
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1007186 | Other | MI | MCLAREN HEALTH ADVANTAGE |
| 1007251 | Other | MI | MCLAREN HEALTH PLAN PIN |
| 348-776-000 | Other | MI | MAGELLAN PIN |
| 68-0-F3-3300-0 | Other | MI | BLUE CROSS PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1606356 | MI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bright Horizons Psychological Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Swartz Creek, MI
- NPI 1972714087
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391990400000",
"number": "1104967405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3495 S CENTER RD",
"city": "BURTON",
"state": "MI",
"postal_code": "485191455",
"telephone_number": "810-424-2011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8435 HOLLY RD",
"city": "GRAND BLANC",
"state": "MI",
"postal_code": "484391812",
"telephone_number": "810-424-2400",
"fax_number": "810-579-7222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOERGEN",
"first_name": "MARIANNE",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-09",
"last_updated": "2014-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "1606356",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN HEALTH ADVANTAGE",
"identifier": "1007186",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN HEALTH PLAN PIN",
"identifier": "1007251",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN PIN",
"identifier": "348-776-000",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PIN",
"identifier": "68-0-F3-3300-0",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Blanc, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.