NPIMap

Individual provider Active NPI

Mark P. McGovern, PH.D.

  • Psychologist
  • Lebanon, NH
National Provider Identifier
1164805891
Registry record updated Jun 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
932 Issued in NH
Practice address
85 Mechanic St
Suite B4-1
Lebanon, NH 03766-1537
Phone
(603) 381-1160
Fax
(603) 448-3976
NPI assigned
Jun 30, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 932 NH Primary
Addiction (Substance Use Disorder) Psychologist 103TA0400X 932 NH

Addresses

Primary practice location

85 Mechanic St
Suite B4-1
Lebanon, NH 03766-1537

Mailing address

85 Mechanic St
Suite B4-1
Lebanon, NH 03766-1537
Phone (603) 381-1160

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
932NHMDAddiction (Substance Use Disorder) Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435622400000",
    "number": "1164805891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 MECHANIC ST",
            "address_2": "SUITE B4-1",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037661537",
            "telephone_number": "603-381-1160",
            "fax_number": "603-448-3976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 MECHANIC ST",
            "address_2": "SUITE B4-1",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037661537",
            "telephone_number": "603-381-1160",
            "fax_number": "603-448-3976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGOVERN",
        "first_name": "MARK",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-30",
        "last_updated": "2015-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NH",
            "license": "932",
            "primary": true
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "NH",
            "license": "932",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.