Active NPI
Mara Rose Dockendorf, PSY.D.
- Psychologist
- Minneapolis, MN
National Provider Identifier
1588014054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP6445
- Practice address
- 310 Clifton Ave
Minneapolis, MN 55403-3218 - Phone
- (612) 223-8898
- Fax
- (612) 223-8899
- NPI assigned
- Jun 15, 2016
- Last updated
- Sep 16, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | CC01251 | MN | |
| Psychologist | 103T00000X | LP6445 | MN | Primary |
Addresses
Primary practice location
310 Clifton Ave
Minneapolis, MN 55403-3218
Mailing address
310 Clifton Ave
Minneapolis, MN 55403-3218
Phone (612) 223-8898
Other names 1
- Mara Rose Clements
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CC01251 | MN | MD | Professional Counselor |
| LP6445 | MN | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fraser | Past | Accepting new patients | |
| Growth and Wellness Counseling PLLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Rehabilitation Clinic/Center
- Richfield, MN
- NPI 1063568574
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568592000000",
"number": "1588014054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 CLIFTON AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554033218",
"telephone_number": "612-223-8898",
"fax_number": "612-223-8899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 CLIFTON AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554033218",
"telephone_number": "612-223-8898",
"fax_number": "612-223-8899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOCKENDORF",
"first_name": "MARA",
"middle_name": "ROSE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-15",
"last_updated": "2019-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MN",
"license": "CC01251",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP6445",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARA",
"last_name": "CLEMENTS",
"middle_name": "ROSE",
"credential": "M.A.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.