Active NPI
Mandy Conrad
- Counseling Psychologist
- Riverside, RI
National Provider Identifier
1316609027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- Practice address
- 375 Wampanoag TRL
Riverside, RI 02915-2232 - Phone
- (401) 649-4020
- NPI assigned
- Oct 10, 2021
- Last updated
- Oct 23, 2021
- 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 | Primary |
Addresses
Primary practice location
375 Wampanoag TRL
Riverside, RI 02915-2232
Mailing address
110 Elm St FL 3
Providence, RI 02903-4626
Phone (401) 649-4020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in RI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220221000930 | RI | Practitioner - Clinical Psychologist | 9234523028 |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Stanford University School of Medicine, 2021
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
375 Wampanoag TRL
Riverside, RI 02915-2232
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634947200000",
"number": "1316609027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 ELM ST FL 3",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029034626",
"telephone_number": "401-649-4020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "375 WAMPANOAG TRL",
"city": "RIVERSIDE",
"state": "RI",
"postal_code": "029152232",
"telephone_number": "401-649-4020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONRAD",
"first_name": "MANDY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-10",
"last_updated": "2021-10-23",
"certification_date": "2021-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2021; 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.