Active NPI
Mary Boyd Neal, PH.D., LMFT
- Marriage & Family Therapist
- St Augustine, FL
National Provider Identifier
1508075789
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MT2223
- Practice address
- 320 High Tide Dr
Suite 101
St Augustine, FL 32080-2323 - Phone
- (904) 392-1704
- Fax
- (904) 460-0068
- NPI assigned
- May 22, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MT2223 | FL | Primary |
Addresses
Primary practice location
320 High Tide Dr
Suite 101
St Augustine, FL 32080-2323
Mailing address
320 High Tide Dr
Suite 101
St Augustine, FL 32080-2323
Phone (904) 392-1704
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 510603971 | Other | FL | FEIN |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT2223 | FL | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237939200000",
"number": "1508075789",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 HIGH TIDE DR",
"address_2": "SUITE 101",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320802323",
"telephone_number": "904-392-1704",
"fax_number": "904-460-0068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 HIGH TIDE DR",
"address_2": "SUITE 101",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320802323",
"telephone_number": "904-392-1704",
"fax_number": "904-460-0068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEAL",
"first_name": "MARY",
"middle_name": "BOYD",
"name_prefix": "Dr.",
"credential": "PH.D., LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-22",
"last_updated": "2009-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "FL",
"license": "MT2223",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEIN",
"identifier": "510603971",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.