NPIMap

Organization Active NPI

Manifest Psychology, Inc.

  • Clinical Psychologist
  • Stuart, FL
National Provider Identifier
1487200168
Registry record updated May 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
MANIFEST PSYCHOLOGY, INC.
Practice address
900 SE Ocean Blvd Ste 250F
Stuart, FL 34994-3501
Phone
(772) 242-9950
Fax
(754) 206-1978
NPI assigned
Aug 17, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2022

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

Authorized official

Name
Dr. Laura Goldman, PSYDNPI 1033617220
Title
President
Phone
(772) 242-9950

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

900 SE Ocean Blvd Ste 250F
Stuart, FL 34994-3501

Mailing address

900 SE Ocean Blvd Ste 250F
Stuart, FL 34994-3501
Phone (772) 242-9950

Other practice location 1

2514 Hollywood Blvd Ste 500
Hollywood, FL 33020-6635
Phone (954) 744-1268

Other names 1

  • Laura Goldman PSYD PA Former legal business name

National Provider Directory

National Provider Directory

Locations

2514 Hollywood Blvd
Ste 404
Hollywood, FL 33020

900 SE Ocean Blvd
Ste 250F
Stuart, FL 34994
Phone (772) 242-9950

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1566000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652572800000",
    "number": "1487200168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 SE OCEAN BLVD STE 250F",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349943501",
            "telephone_number": "772-242-9950",
            "fax_number": "754-206-1978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SE OCEAN BLVD STE 250F",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349943501",
            "telephone_number": "772-242-9950",
            "fax_number": "754-206-1978"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2514 Hollywood Blvd Ste 500",
            "address_purpose": "LOCATION",
            "city": "Hollywood",
            "state": "FL",
            "postal_code": "330206635",
            "country_code": "US",
            "telephone_number": "954-744-1268",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MANIFEST PSYCHOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-17",
        "last_updated": "2022-05-15",
        "certification_date": "2022-05-15",
        "status": "A",
        "authorized_official_last_name": "GOLDMAN",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "772-242-9950",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laura Goldman PSYD PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Stuart, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2022; 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.