NPIMap

Organization Active NPI

Child Neurobehavioral Center for Health & Wellness, PC

  • Psychologist
  • Martinez, GA
National Provider Identifier
1295898476
Registry record updated Apr 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2381 Issued in GA
Legal business name
CHILD NEUROBEHAVIORAL CENTER FOR HEALTH & WELLNESS, PC
Practice address
302 Baston Rd
Martinez, GA 30907-2906
Phone
(706) 447-8700
Fax
(706) 447-8701
NPI assigned
Dec 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2014

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

Authorized official

Name
Dr. Maria E Gangarosa Emerson, PHDNPI 1144437989
Title
Owner
Phone
(706) 447-8700

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
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X 2381 GA
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 2381 GA Primary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

302 Baston Rd
Martinez, GA 30907-2906

Mailing address

PO Box 2854
Evans, GA 30809-2854
Phone (706) 447-8700

Other identifiers 2

IdentifierTypeStateIssuer
52669312-001OtherGABCBS
000852277BMedicaidGA

Other names 1

  • Maria E Gangarosa-Emerson, PhD, PC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Child Neuro Health and Wellness Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396483200000",
    "number": "1295898476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2854",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308092854",
            "telephone_number": "706-447-8700",
            "fax_number": "770-447-8701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 BASTON RD",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309072906",
            "telephone_number": "706-447-8700",
            "fax_number": "706-447-8701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD NEUROBEHAVIORAL CENTER FOR HEALTH & WELLNESS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2014-04-03",
        "status": "A",
        "authorized_official_last_name": "GANGAROSA EMERSON",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-447-8700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "GA",
            "license": "2381",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "GA",
            "license": "2381",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52669312-001",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000852277B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maria E Gangarosa-Emerson, PhD, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Martinez, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2014; 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.