Active NPI
Ross Lowell Mayberry, PH.D.
- Psychologist
- Edmonds, WA
National Provider Identifier
1609948678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- WAPSY1297
- Practice address
- 1402 10TH PL N
Edmonds, WA 98020-2629 - Phone
- (206) 735-9592
- Fax
- (206) 323-7324
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | PSY 1297 | WA | |
| Psychologist | 103T00000X | WAPSY1297 | WA | Primary |
Addresses
Primary practice location
1402 10TH PL N
Edmonds, WA 98020-2629
Mailing address
1402 10TH PL N
Edmonds, WA 98020-2629
Phone (206) 735-9592
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 91-1985428 | Other | TAX ID # |
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 |
|---|---|---|---|
| WAPSY1297 | WA | MD | Psychologist |
| PSY 1297 | WA | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706140800000",
"number": "1609948678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1402 10TH PL N",
"city": "EDMONDS",
"state": "WA",
"postal_code": "980202629",
"telephone_number": "206-735-9592",
"fax_number": "206-323-7324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1402 10TH PL N",
"city": "EDMONDS",
"state": "WA",
"postal_code": "980202629",
"telephone_number": "206-735-9592",
"fax_number": "206-323-7324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYBERRY",
"first_name": "ROSS",
"middle_name": "LOWELL",
"name_prefix": "Mr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-15",
"last_updated": "2024-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "WA",
"license": "PSY 1297",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WA",
"license": "WAPSY1297",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID #",
"identifier": "91-1985428",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Edmonds, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.