Mary Elizabeth Vandergoot, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6201002122 Issued in MI

Practice address

60 Monroe Ctr NW
Suite 8-D
Grand Rapids, MI 49503-2916

Phone

(616) 957-3477

NPI assigned

Jan 26, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315958400000",
    "number": "1447220819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MONROE CTR NW",
            "address_2": "SUITE 8-D",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032916",
            "telephone_number": "616-957-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MONROE CTR NW",
            "address_2": "SUITE 8-D",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032916",
            "telephone_number": "616-957-3477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERGOOT",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-26",
        "last_updated": "2011-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6201002122",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MI",
            "license": "4101005656",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "680D14542",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin Lousise Vanderark
• Janna Vanderband, ATR-P
• Ronald Vanderbeck, PSYD
• Ethan Vanderberg
• Emily Michelle Vanderburg
• Madeline Vandergraaf
• Julie Lynne Vanderhart, M.S.P.T.
• Hope Vanderheide
• Brianne Vanderhelm
• Matthew Vanderhyde

• Psychologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.