NPIMap

Organization Active NPI

Memory Clinic, Inc.

  • Behavioral Neurology & Neuropsychiatry Physician
  • Bennington, VT
National Provider Identifier
1205359213
Registry record updated Mar 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavioral Neurology & Neuropsychiatry PhysicianTaxonomy code 2084B0040X
Legal business name
MEMORY CLINIC, INC.
Practice address
357 Shields Dr
Bennington, VT 05201-9810
Phone
(802) 447-1409
NPI assigned
Jul 21, 2017
Last updated
Mar 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2021

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

Authorized official

Name
Dr. Cynthia Murphy, PSYD, MBANPI 1851483028
Title
Director
Phone
(802) 447-1409

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X
Psychologist 103T00000X
Psychiatry Physician 2084P0800X
Behavioral Neurology & Neuropsychiatry Physician 2084B0040X Primary

Addresses

Primary practice location

357 Shields Dr
Bennington, VT 05201-9810

Mailing address

357 Shields Dr
Bennington, VT 05201-9810

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200701002464 VT Part B Supplier - Clinic/Group Practice 6709209109 Receives reassigned benefits from 7 practitioners
Practice locations: Bennington, VT

National Provider Directory

National Provider Directory

Locations

357 Shields Dr
Bennington, VT 05201
Phone (802) 442-3757

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1500595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615852800000",
    "number": "1205359213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "357 SHIELDS DR",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052019810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 SHIELDS DR",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052019810",
            "telephone_number": "802-447-1409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-21",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A",
        "authorized_official_last_name": "MURPHY",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "802-447-1409",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, MBA"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bennington, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.