Individual provider Active NPI

Denise Acker Marandola, PH.D

  • Psychologist
  • Sioux City, IA
National Provider Identifier
1376630277
Registry record updated May 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
00805 Issued in IA
Practice address
2212 Pierce St
Ste. 100
Sioux City, IA 51104-3871
Phone
(712) 255-8323
Fax
(712) 255-8287
NPI assigned
Oct 10, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 11, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 00805 IA Primary

Addresses

Primary practice location

2212 Pierce St
Ste. 100
Sioux City, IA 51104-3871

Mailing address

2212 Pierce St
Ste. 100
Sioux City, IA 51104-3871
Phone (712) 255-8323

Other identifiers 1

IdentifierTypeStateIssuer
1152322MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20101020000521 IA Practitioner - Clinical Psychologist 3870499940 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physicians Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431302400000",
    "number": "1376630277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2212 PIERCE ST",
            "address_2": "STE. 100",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511043871",
            "telephone_number": "712-255-8323",
            "fax_number": "712-255-8287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2212 PIERCE ST",
            "address_2": "STE. 100",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511043871",
            "telephone_number": "712-255-8323",
            "fax_number": "712-255-8287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARANDOLA",
        "first_name": "DENISE",
        "middle_name": "ACKER",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2015-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IA",
            "license": "00805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1152322",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux City, IA

Sources for this page

Verify at the official NPI Registry.