Mervin R Smucker, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1538-057 Issued in WI

Practice address

6110 N Port Washington Rd
Milwaukee, WI 53217-4308

Phone

(414) 403-4949

Fax

(574) 537-0567

NPI assigned

Jan 2, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215094917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CARTER RD",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465265201",
            "telephone_number": "414-403-4949",
            "fax_number": "574-537-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6110 N PORT WASHINGTON RD",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532174308",
            "telephone_number": "414-403-4949",
            "fax_number": "574-537-0567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMUCKER",
        "first_name": "MERVIN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "1538-057",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20041542",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olexandr V. Smolensky, M.D.
• Amanda Rose Smolock
• Katrina Smoot
• Jon Maurice Smoots
• Smoove Ride Transportation
• Mark B Smuckler, M.D.
• Joel D Smukowski, MD
• David Victor Smullen, MD
• Grant Michael Smurawa, RN
• Laura Smy, PHD

• Clinical Psychologist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Clinical Psychologist in Wisconsin

• 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.

Verify at the official NPI Registry.