Active NPI
Jennifer Boss Mainka, M.S., L.L.P.
- Clinical Psychologist
- Brighton, MI
National Provider Identifier
1417111386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301013056
- Practice address
- 324 W Main St
Suite 4
Brighton, MI 48116-1591 - Phone
- (810) 227-6218
- Fax
- (810) 227-6982
- NPI assigned
- Jul 10, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301013056 | MI | Primary |
Addresses
Primary practice location
324 W Main St
Suite 4
Brighton, MI 48116-1591
Mailing address
324 W Main St
Suite 4
Brighton, MI 48116-1591
Phone (810) 227-6218
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301013056 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215648000000",
"number": "1417111386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "324 W MAIN ST",
"address_2": "SUITE 4",
"city": "BRIGHTON",
"state": "MI",
"postal_code": "481161591",
"telephone_number": "810-227-6218",
"fax_number": "810-227-6982"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "324 W MAIN ST",
"address_2": "SUITE 4",
"city": "BRIGHTON",
"state": "MI",
"postal_code": "481161591",
"telephone_number": "810-227-6218",
"fax_number": "810-227-6982"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAINKA",
"first_name": "JENNIFER",
"middle_name": "BOSS",
"credential": "M.S., L.L.P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-10",
"last_updated": "2008-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301013056",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brighton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.