Mary Enright, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3542-57 Issued in WI

Practice address

1720 W Florist Ave Ste 125
Glendale, WI 53209-3862

Phone

(414) 247-0801

Fax

(141) 247-0816

NPI assigned

Aug 7, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sebastian Family Psycholgy Practice

  • Professional Counselor
  • Glendale, WI
  • NPI 1124441373
  NPD (past)
• Sebastian Family Psycholgy Practice

  • Mental Health Counselor
  • Glendale, WI
  • NPI 1316360092
  NPD (past)

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

{
    "created_epoch": "1407369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517788800000",
    "number": "1548679103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 W FLORIST AVE STE 125",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532093862",
            "telephone_number": "414-247-0801",
            "fax_number": "141-247-0816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 W FLORIST AVE STE 125",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532093862",
            "telephone_number": "414-247-0801",
            "fax_number": "141-247-0816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENRIGHT",
        "first_name": "MARY",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-07",
        "last_updated": "2018-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "2180-226",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "3542-57",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "2180-226",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Embody Therapy LLC (Shoreside Therapies Glendale)
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• Eye Care Optical (Specs Appeal)

• Psychologist in Glendale, WI
• Providers in Glendale, WI by specialty
• Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2018; 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.