Martha Dedricks, PSYD
Individual provider Active NPI Clinical Psychologist · Tallahassee, FL
NPI 1144453036 · NPPES record last updated Oct 15, 2018
Key facts
- NPI
- 1144453036
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PY9747 (FL)
- Practice address
- 1201 Hays St
Tallahassee, FL 32301-2699 - Phone
- (800) 370-3651
- Fax
- (877) 515-7147
- NPI assigned
- Aug 26, 2009
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Che Behavioral Health Services of Florida, P.a.
Practice addresses (Care Compare)
6750 N Andrews Ave
Suite 200
Ft Lauderdale, FL 33309-2180
Phone (888) 515-3834
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181219000899 | FL | Practitioner - Clinical Psychologist | 7315282373 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY18213 | CA | MD | Clinical Psychologist |
| PY9747 | FL | MD | Clinical Psychologist |
Practice roles (2 of 3)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Multi-Specialty | Current | Accepting new patients |
| Che Behavioral Health Services of Florida, P.a. | Clinical | Current |
Accepting new patients |
Locations
6750 N Andrews Ave
Ste 200
Lauderdale Lakes, FL 33309
Phone (718) 408-5477
Networks
- Freedom Health HMO Network
Interoperability endpoints
- marthadedricks@tdh.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY18213 | CA | |
| Clinical Psychologist |
103TC0700X | PY9747 | FL | Yes |
Addresses
Primary practice location
1201 Hays St
Tallahassee, FL 32301-2699
Mailing address
PO Box 562744
Rockledge, FL 32956-2744
Phone (310) 936-6253
Other practice location 1
1125 South Beverly Drive
#401
Los Angeles, CA 90035
Phone (321) 494-1110
Other providers in Tallahassee, FL
- Allyson Nicole Decastro
- Rosalyn Barrett Deckerhoff
- John A Declue
- Keonna Decree
- Jessica K Dedge
- Al E. Deeb
- Larry Charles Deeb
- Sarah Deem
- Deeper Health, P.a.
- Deerfield Beach Physician Services, LLC
All providers in Tallahassee, FL · Clinical Psychologist in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.