Individual provider Active NPI

Margaret Ruth Mendoza, PSY.D.

  • Student in an Organized Health Care Education/Training Program
  • Watertown, NY
National Provider Identifier
1447767942
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
211 J.B. Wise Plaza
Watertown, NY 13601
Phone
(315) 782-7445
Fax
(315) 779-1184
NPI assigned
Jan 5, 2018
Last updated
Sep 16, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU Primary

Addresses

Primary practice location

211 J.B. Wise Plaza
Watertown, NY 13601

Mailing address

PO Box 6550
Watertown, NY 13601-6550
Phone (315) 788-7430

Other practice location 1

167 Polk St Ste 300
Watertown, NY 13601-2770
Phone (315) 782-7445

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

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Home of Jefferson County Single Specialty CurrentSince Apr 1, 2020 Accepting new patients
Children's Home of Jefferson County CurrentSince Apr 1, 2020 Accepting new patients

Locations

167 Polk St
Ste 300
Watertown, NY 13601

211 Jb Wise Pl
Watertown, NY 13601
Phone (315) 788-7430

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1515110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1447767942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6550",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136016550",
            "telephone_number": "315-788-7430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 J.B. WISE PLAZA",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "13601",
            "telephone_number": "315-782-7445",
            "fax_number": "315-779-1184"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "167 Polk St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Watertown",
            "state": "NY",
            "postal_code": "136012770",
            "country_code": "US",
            "telephone_number": "315-782-7445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "MARGARET",
        "middle_name": "RUTH",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-05",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2020; 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.