Active NPI
John Mangiaracina, PHD
- Clinical Psychologist
- Little Rock, AR
National Provider Identifier
1538300421
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 77-16P
- Practice address
- 305 S Palm St
Little Rock, AR 72205-5432 - Phone
- (501) 686-9406
- Fax
- (501) 686-9588
- NPI assigned
- Mar 23, 2009
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 77-16P | AR | Primary |
Addresses
Primary practice location
305 S Palm St
Little Rock, AR 72205-5432
Mailing address
305 S Palm St
Little Rock, AR 72205-5432
Phone (501) 686-9406
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)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1237766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237766400000",
"number": "1538300421",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 S PALM ST",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722055432",
"telephone_number": "501-686-9406",
"fax_number": "501-686-9588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 S PALM ST",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722055432",
"telephone_number": "501-686-9406",
"fax_number": "501-686-9588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGIARACINA",
"first_name": "JOHN",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-03-23",
"last_updated": "2009-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AR",
"license": "77-16P",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.