Active NPI
Maverick McGovern, LPA
- Psychologist
- New London, NC
National Provider Identifier
1427134584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 0835
- Practice address
- 1252 Lakeshore Dr
New London, NC 28127-6608 - Phone
- (336) 302-3444
- Fax
- (336) 302-3444
- NPI assigned
- Oct 31, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 0835 | NC | Primary |
Addresses
Primary practice location
1252 Lakeshore Dr
New London, NC 28127-6608
Mailing address
1252 Lakeshore Dr
New London, NC 28127-6608
Phone (336) 302-3444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6107459 | Medicaid | NC |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686009600000",
"number": "1427134584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1252 LAKESHORE DR",
"city": "NEW LONDON",
"state": "NC",
"postal_code": "281276608",
"telephone_number": "336-302-3444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1252 LAKESHORE DR",
"city": "NEW LONDON",
"state": "NC",
"postal_code": "281276608",
"telephone_number": "336-302-3444",
"fax_number": "336-302-3444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCGOVERN",
"first_name": "MAVERICK",
"name_prefix": "Mr.",
"credential": "LPA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-31",
"last_updated": "2023-06-06",
"certification_date": "2023-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "0835",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6107459",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in New London, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.