Mary Kathleen Prospero, PH.D.

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

OH4438 Issued in OH

Practice address

4450 Belden Village St NW
Suite 202
Canton, OH 44718-2596

Phone

(330) 492-8494

Fax

(330) 492-8294

NPI assigned

Aug 30, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298937600000",
    "number": "1457344079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4450 BELDEN VILLAGE ST NW",
            "address_2": "SUITE 202",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182596",
            "telephone_number": "330-492-8494",
            "fax_number": "330-492-8294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4450 BELDEN VILLAGE ST NW",
            "address_2": "SUITE 202",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182596",
            "telephone_number": "330-492-8494",
            "fax_number": "330-492-8294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROSPERO",
        "first_name": "MARY",
        "middle_name": "KATHLEEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-30",
        "last_updated": "2011-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "OH",
            "license": "OH4438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0215378",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Counseling Psychologist in Canton, OH
• Providers in Canton, OH by specialty
• Counseling Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 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.