Individual provider Active NPI

Margaret Mary Mannix, PH.D.

  • Clinical Child & Adolescent Psychologist
  • Providence, RI
National Provider Identifier
1124276126
Registry record updated Aug 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
PS01196 Issued in RI
Practice address
593 Eddy St
Potter Basement
Providence, RI 02903-4923
Phone
(401) 444-8368
Fax
(401) 444-2085
NPI assigned
Sep 3, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X PS01196 RI Primary

Addresses

Primary practice location

593 Eddy St
Potter Basement
Providence, RI 02903-4923

Mailing address

593 Eddy St
Apc 978
Providence, RI 02903-4923
Phone (401) 444-4318

Other identifiers 1

IdentifierTypeStateIssuer
PS01196OtherRIPROFESSIONAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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

Enrollment IDStateProvider typePAC IDDetails
I20101021001074 RI Practitioner - Clinical Psychologist 9032302161 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. CurrentSince Apr 17, 2013 Accepting new patients
Rhode Island Hospital CurrentSince Oct 1, 2022 Accepting new patients
Lifespan Physician Group, Inc. Clinical Child & Adolescent CurrentSince Apr 17, 2013 Accepting new patients
Rhode Island Hospital Clinical Child & Adolescent CurrentSince Oct 1, 2022 Accepting new patients

Locations

1454 S County Trl
Ste 2100
East Greenwich, RI 02818
Phone (401) 606-2000

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

593 Eddy St
Ste 105
Providence, RI 02903
Phone (401) 444-5241

593 Eddy St
#978
Providence, RI 02903
Phone (401) 444-4318

593 Eddy St
Rm 38
Providence, RI 02903
Phone (401) 444-4779

593 Eddy St
Providence, RI 02903

593 Eddy St
Ste 5
Providence, RI 02903
Phone (401) 444-3996

593 Eddy St
Bsmt
Providence, RI 02903
Phone (401) 444-8368

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282262400000",
    "number": "1124276126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "APC 978",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-4318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "POTTER BASEMENT",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-8368",
            "fax_number": "401-444-2085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANNIX",
        "first_name": "MARGARET",
        "middle_name": "MARY",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-03",
        "last_updated": "2010-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "RI",
            "license": "PS01196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE",
            "identifier": "PS01196",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.