Individual provider Active NPI

Laura Begault, PH.D.

  • Clinical Psychologist
  • Palm Bay, FL
National Provider Identifier
1558390674
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY7059 Issued in FL
Practice address
2123 Franklin Dr NE
Palm Bay, FL 32905-4022
Phone
(321) 724-1614
Fax
(321) 722-3590
NPI assigned
Jul 1, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY7059 FL Primary

Addresses

Primary practice location

2123 Franklin Dr NE
Palm Bay, FL 32905-4022

Mailing address

2123 Franklin Dr NE
Palm Bay, FL 32905-4022
Phone (321) 724-1614

Other identifiers 1

IdentifierTypeStateIssuer
74455OtherFLBLUE CROSS BLUE SHIELD

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": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1558390674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2123 FRANKLIN DR NE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329054022",
            "telephone_number": "321-724-1614",
            "fax_number": "321-722-3590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2123 FRANKLIN DR NE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329054022",
            "telephone_number": "321-724-1614",
            "fax_number": "321-722-3590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEGAULT",
        "first_name": "LAURA",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY7059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "74455",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.