Manfredo Florescruz

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2023049778 Issued in MO

Practice address

600 East Fifith Street
Fulton, MO 65251

Phone

(573) 592-2030

NPI assigned

Sep 25, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• State of Missouri

  dba Fulton State Hospital

  • Psychiatry Physician
  • Fulton, MO
  • NPI 1164477873

  Psychologist

  Medicare reassignment NPD
• State of Missouri

  dba Developmental Disabilities Behavior Services

  • Psychiatry Physician
  • Kansas City, MO
  • NPI 1386198448
  NPD

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

{
    "created_epoch": "1727222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1407673908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 EAST FIFITH STREET",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "65251",
            "telephone_number": "573-592-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 EAST FIFITH STREET",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "65251",
            "telephone_number": "573-592-2030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLORESCRUZ",
        "first_name": "MANFREDO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-25",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MO",
            "license": "2023049778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Counseling Center of Missouri Inc
• Shelby Teresa Feltrop, ATS
• Judith A Fisher, DO
• Amy Alexander Fleming, AU.D.
• Rachael Fletcher, PT, DPT, ATC
• Ashleigh Fox, LCSW
• Brittanie Frost, RN
• Amy N Fuemmeler, LPC
• Fulton Family Health Associates, P.C.
• Fulton Manor Inc (Fulton Manor Care Center)

• Psychologist in Fulton, MO
• Providers in Fulton, MO by specialty
• Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.