Active NPI
Nicole Eldridge Marcus, PHD
- Clinical Psychologist
- Pinecrest, FL
National Provider Identifier
1578283867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY7161
- Practice address
- 7685 SW 104TH St Ste 100
Pinecrest, FL 33156-3161 - Phone
- (305) 877-3333
- NPI assigned
- Aug 29, 2022
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY7161 | FL | Primary |
Addresses
Primary practice location
7685 SW 104TH St Ste 100
Pinecrest, FL 33156-3161
Mailing address
7685 SW 104TH St Ste 100
Pinecrest, FL 33156-3161
Phone (305) 877-3333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669517462 | Other | FL | NPPES |
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 |
|---|---|---|---|
| PY7161 | FL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661731200000",
"number": "1578283867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7685 SW 104TH ST STE 100",
"city": "PINECREST",
"state": "FL",
"postal_code": "331563161",
"telephone_number": "305-877-3333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7685 SW 104TH ST STE 100",
"city": "PINECREST",
"state": "FL",
"postal_code": "331563161",
"telephone_number": "305-877-3333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARCUS",
"first_name": "NICOLE",
"middle_name": "ELDRIDGE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-29",
"last_updated": "2022-08-29",
"certification_date": "2022-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY7161",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPPES",
"identifier": "1669517462",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pinecrest, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.