Active NPI
Merriam Park Psychological Services, PA
- Psychologist
- St. Paul, MN
National Provider Identifier
1194937623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Legal business name
- MERRIAM PARK PSYCHOLOGICAL SERVICES, PA
- Practice address
- 1678 Selby Avenue
St. Paul, MN 55104 - Phone
- (651) 647-5722
- Fax
- (651) 647-5723
- NPI assigned
- May 4, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Alison C Maule-Kronmiller
- Title
- Psychologist
- Phone
- (651) 647-5722
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
1678 Selby Avenue
St. Paul, MN 55104
Mailing address
1678 Selby Avenue
St. Paul, MN 55104
Phone (651) 647-5722
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 826823100 | Other | MN | MEDICAL ASSISTANCE |
| 01H82MA | Other | MN | BCBS GROUP PROVIDER # |
| 01H83MA | Other | MN | BCBS IND. PROVIDER # |
| 107019 | Other | MN | UCARE |
| 6126079 | Other | MN | UBH |
| 1016735 | Other | MN | PREFERRED ONE |
| 6126079 | Other | MN | MEDICA |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1274832000000",
"number": "1194937623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1678 SELBY AVENUE",
"city": "ST. PAUL",
"state": "MN",
"postal_code": "55104",
"telephone_number": "651-647-5722",
"fax_number": "651-647-5723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1678 SELBY AVENUE",
"city": "ST. PAUL",
"state": "MN",
"postal_code": "55104",
"telephone_number": "651-647-5722",
"fax_number": "651-647-5723"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MERRIAM PARK PSYCHOLOGICAL SERVICES, PA",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-04",
"last_updated": "2010-05-26",
"status": "A",
"authorized_official_last_name": "MAULE-KRONMILLER",
"authorized_official_first_name": "ALISON",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "PSYCHOLOGIST",
"authorized_official_telephone_number": "651-647-5722"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL ASSISTANCE",
"identifier": "826823100",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS GROUP PROVIDER #",
"identifier": "01H82MA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS IND. PROVIDER #",
"identifier": "01H83MA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "107019",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH",
"identifier": "6126079",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1016735",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "6126079",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in St. Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.