Mary Elizabeth Klotz, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1222 Issued in NM

Practice address

2811 Indian School Rd NE
Albuquerque, NM 87106-1825

Phone

(505) 449-7209

NPI assigned

Sep 30, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Mary Elizabeth Bancroft Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Jumpstart, LLC

  • Behavior Analyst
  • Albuquerque, NM
  • NPI 1225206105
  NPD (past)
• Jumpstart, LLC

  • Clinical Child & Adolescent Psychologist
  • Albuquerque, NM
  • NPI 1477386852
  NPD (past)

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

{
    "created_epoch": "1254268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1295069839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2811 INDIAN SCHOOL RD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871061825",
            "telephone_number": "505-449-7209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 INDIAN SCHOOL RD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871061825",
            "telephone_number": "505-449-7209"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8500 Washington St NE Ste A1",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "87108",
            "country_code": "US",
            "telephone_number": "505-828-3837",
            "fax_number": "877-828-1550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLOTZ",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-30",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NM",
            "license": "1222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65078721",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "BANCROFT",
            "middle_name": "ELIZABETH",
            "credential": "PHD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Beverly Kloeppel, MD
• Carmen Isabella Kloer, MD
• Jeffrey M Kloer, P.T.
• Lee Anne Klombies, OTR/L
• Simran Kloty
• Ralph Jonathan Klotzbaugh, NP
• Taeja Kluge, M.S., BCBA
• KM Cares, LLC
• Kellison Kmatz
• KMS, LLC

• Psychologist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Psychologist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; 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.