Active NPI
Maryanne Bongiovani
- Clinical Child & Adolescent Psychologist
- Ellicott City, MD
National Provider Identifier
1164570354
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 02316
- Practice address
- 9050 Chevrolet Dr
Ellicott City, MD 21042-4018 - Phone
- (410) 750-9493
- NPI assigned
- Jan 6, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 Child & Adolescent Psychologist | 103TC2200X | 02316 | MD | Primary |
Addresses
Primary practice location
9050 Chevrolet Dr
Ellicott City, MD 21042-4018
Mailing address
10527 Dorchester Way
Woodstock, MD 21163-1377
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02316 | MD | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164570354",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10527 DORCHESTER WAY",
"city": "WOODSTOCK",
"state": "MD",
"postal_code": "211631377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9050 CHEVROLET DR",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210424018",
"telephone_number": "410-750-9493"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONGIOVANI",
"first_name": "MARYANNE",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MD",
"license": "02316",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellicott City, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.