Maryanna Elizabeth Manderville, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2878 Issued in AL

Practice address

2637 Eastern Blvd
Montgomery, AL 36117

Phone

(334) 409-9090

Fax

(334) 409-9669

NPI assigned

Sep 13, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Gardenia Cove Mental Health PCGroup PAC ID 0648534537, 40 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Gardenia Cove Mental Health PC

  • Psychiatry Physician
  • Montgomery, AL
  • NPI 1063912301
  Medicare reassignment Care Compare group NPD
• Alabama Psychiatric Services PC

  • Psychiatry Physician
  • Birmingham, AL
  • NPI 1033159306
  NPD (past)

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

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315872000000",
    "number": "1285916593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2868 ACTON ROAD",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "35243",
            "telephone_number": "205-968-8360",
            "fax_number": "205-968-8361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2637 EASTERN BLVD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "36117",
            "telephone_number": "334-409-9090",
            "fax_number": "334-409-9669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDERVILLE",
        "first_name": "MARYANNA",
        "middle_name": "ELIZABETH",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-13",
        "last_updated": "2011-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AL",
            "license": "2878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah L. Mallory, CRNA
• Thomas A. Mallory, CRNA
• Calyn Ashley Malloy, RN, MSN, FNP-C
• Margaret Doreen Maloney, MD
• Stephan Idris Mambazo, MSW, LICSW-PIP, CGRS
• Joseph Anthony Mangini, M.D.
• Robbie Mangum, M.S.,NCC,LPC
• Ashley Cannon Mann, CRNP
• Clint D Mann, DPT
• Kelly Mann, CRNP

• Professional Counselor in Montgomery, AL
• Providers in Montgomery, AL by specialty
• Professional Counselor in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.