Individual provider Active NPI

Mary E Neff, PSYD

  • Clinical Psychologist
  • Milwaukee, WI
National Provider Identifier
1407264047
Registry record updated May 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3280-057 Issued in WI
Practice address
5555 N Port Washington Road
Suite 300
Milwaukee, WI 53217-4928
Phone
(414) 962-6764
Fax
(414) 962-6765
NPI assigned
Jul 28, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 6, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 5392 - 125 WI
Clinical Psychologist 103TC0700X 3280-57 WI
Clinical Psychologist 103TC0700X 3280-057 WI Primary

Addresses

Primary practice location

5555 N Port Washington Road
Suite 300
Milwaukee, WI 53217-4928

Mailing address

5555 N Port Washington Road
Suite 300
Milwaukee, WI 53217-4928
Phone (414) 962-6764

Other identifiers 1

IdentifierTypeStateIssuer
100039912MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20161209001899 WI Practitioner - Clinical Psychologist 3971883422 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Waukesha CountyGroup PAC ID 3971405481, 29 clinicians

Practice addresses (Care Compare)

514 Riverview Ave
Waukesha, WI 53188-3631
Phone (262) 548-8431

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5392 - 125WIMDProfessional Counselor
3280-057WIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Waukesha County CurrentSince Jun 22, 2023 Accepting new patients
Waukesha County Current Accepting new patients
Waukesha County CurrentSince Jun 22, 2023 Accepting new patients
North Shore Psychotherapy Associates IV Clinical CurrentSince Jul 1, 2015 Accepting new patients

Locations

5800 N Bayshore Dr
#A250
Glendale, WI 53217
Phone (414) 962-6764

5555 N Port Washington Rd
Ste 300
Glendale, WI 53217
Phone (414) 962-6764

5800 N Bayshore Dr
Ste A250
Milwaukee, WI 53217
Phone (414) 962-6764

514 Riverview Ave
Waukesha, WI 53188
Phone (262) 548-7212

1501 Airport Rd
Waukesha, WI 53188
Phone (262) 548-7950

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1406505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1407264047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 N PORT WASHINGTON ROAD",
            "address_2": "SUITE 300",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532174928",
            "telephone_number": "414-962-6764",
            "fax_number": "414-962-6765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 N PORT WASHINGTON ROAD",
            "address_2": "SUITE 300",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532174928",
            "telephone_number": "414-962-6764",
            "fax_number": "414-962-6765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEFF",
        "first_name": "MARY",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-28",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "5392 - 125",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "3280-57",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "3280-057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100039912",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.