Marianne L McCain PH D P a

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY0004162 Issued in FL

Legal business name

MARIANNE L MCCAIN PH D P A

Practice address

118 Truxton Ave
Fort Walton Beach, FL 32547-2461

Phone

(850) 664-7690

Fax

(850) 664-7691

NPI assigned

Apr 18, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Marianne Lisa McCain, PH.D.NPI 1699749846

Title

President

Phone

(850) 664-7690

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marianne L McCain, PH.D.

  • Clinical Psychologist
  • Fort Walton Beach, FL
  • NPI 1699749846
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208476800000",
    "number": "1467626614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 TRUXTON AVE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325472461",
            "telephone_number": "850-664-7690",
            "fax_number": "850-664-7691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 TRUXTON AVE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325472461",
            "telephone_number": "850-664-7690",
            "fax_number": "850-664-7691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIANNE L MCCAIN PH D P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-18",
        "last_updated": "2008-04-18",
        "status": "A",
        "authorized_official_last_name": "MCCAIN",
        "authorized_official_first_name": "MARIANNE",
        "authorized_official_middle_name": "LISA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-664-7690",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY0004162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mariposa Speech Therapy LLC
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• Clinical Psychologist in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.