Elena Mayville, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

021223 Issued in NY

Practice address

1004 W Fort St
Boise, ID 83702-5427

Phone

(212) 254-3967

NPI assigned

Jul 1, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Dec 11, 2017 through Dec 11, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1437446176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 W FORT ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837025427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 W FORT ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837025427",
            "telephone_number": "212-254-3967"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 E 61st St Ph Floor",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100658722",
            "country_code": "US",
            "telephone_number": "212-821-0714",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAYVILLE",
        "first_name": "ELENA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-01",
        "last_updated": "2023-06-27",
        "certification_date": "2022-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ID",
            "license": "203487",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "021223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karine Maynard
• Wesley J Maynard, MBA, MSW
• Jeremy A Mayo, DPT
• Korene D Mayo, ATC, LAT
• Susan Mayo, P.T.
• Rehema Mazambi Jr.
• Bethany Kendall Maze, FNP
• Sarah E Maze, MD
• Patricia Collins Mazul, ATR-BC
• Alphonse Mbarushimana

• Clinical Psychologist in Boise, ID
• Providers in Boise, ID by specialty
• Clinical Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.