NPIMap

Organization Active NPI

Mary Ann Clark PH D & Associates PA

  • Clinical Psychologist
  • Bradenton, FL
National Provider Identifier
1407030018
Registry record updated Apr 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY0004772 Issued in FL
Legal business name
MARY ANN CLARK PH D & ASSOCIATES PA
Practice address
300 Riverside Dr E
Suite 2000
Bradenton, FL 34208-1008
Phone
(941) 746-8822
Fax
(941) 746-8844
NPI assigned
Dec 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2008

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

Authorized official

Name
Dr. Mary Ann Clark, PH.D.
Title
Owner/President
Phone
(941) 746-8822

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PY0004772 FL Primary

Addresses

Primary practice location

300 Riverside Dr E
Suite 2000
Bradenton, FL 34208-1008

Mailing address

300 Riverside Dr E
Suite 2000
Bradenton, FL 34208-1008
Phone (941) 746-8822

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207872000000",
    "number": "1407030018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 RIVERSIDE DR E",
            "address_2": "SUITE 2000",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342081008",
            "telephone_number": "941-746-8822",
            "fax_number": "941-746-8844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 RIVERSIDE DR E",
            "address_2": "SUITE 2000",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342081008",
            "telephone_number": "941-746-8822",
            "fax_number": "941-746-8844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY ANN CLARK PH D & ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-19",
        "last_updated": "2008-04-11",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "MARY ANN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "941-746-8822",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY0004772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; 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.