Active NPI
Angela Marotta Garrison, PH.D.
- Counseling Psychologist
- West Lafayette, IN
National Provider Identifier
1215193339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 20042857A
- Practice address
- 703 Third Street RM. 1120 Psyc
Purdue University Caps
West Lafayette, IN 47907-2081 - Phone
- (765) 494-6995
- Fax
- (765) 494-6995
- NPI assigned
- Jul 29, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 20042857A | IN | Primary |
Addresses
Primary practice location
703 Third Street RM. 1120 Psyc
Purdue University Caps
West Lafayette, IN 47907-2081
Mailing address
703 Third Street RM. 1120 Psyc
Purdue University Caps
West Lafayette, IN 47907-2081
Phone (765) 494-6995
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20042857A | IN | MD | Counseling Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Modern Mental Health, Inc. | Counseling | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463443200000",
"number": "1215193339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "703 THIRD STREET RM. 1120 PSYC",
"address_2": "PURDUE UNIVERSITY CAPS",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479072081",
"telephone_number": "765-494-6995",
"fax_number": "765-494-6995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "703 THIRD STREET RM. 1120 PSYC",
"address_2": "PURDUE UNIVERSITY CAPS",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479072081",
"telephone_number": "765-494-6995",
"fax_number": "765-494-6995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARRISON",
"first_name": "ANGELA",
"middle_name": "MAROTTA",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-29",
"last_updated": "2016-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "IN",
"license": "20042857A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.