NPIMap

Organization Active NPI

Associated Psychologists PLC

  • Clinical Psychologist
  • Saint Clair Shores, MI
National Provider Identifier
1629112420
Registry record updated Jun 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
ASSOCIATED PSYCHOLOGISTS PLC
Doing business as
Associated Psychologists PLC
Practice address
19900 10 Mile Road
Ste 102
St Clair Shores, MI 48080
Phone
(586) 776-3366
Fax
(586) 776-3369
NPI assigned
Feb 16, 2007
Last updated
Jun 5, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2019

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

Authorized official

Name
Dr. Ronald H Boardway, PH.DNPI 1881703858
Title
Owner
Phone
(586) 776-3366

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X NU Primary

Addresses

Primary practice location

19900 10 Mile Road
Ste 102
St Clair Shores, MI 48080

Mailing address

19900 10 Mile Road
Ste 102
St Clair Shores, MI 48080
Phone (586) 776-3366

Other names 1

  • Associated Psychologists PLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100122000013 MI Part B Supplier - Clinic/Group Practice 5799827218 Receives reassigned benefits from 8 practitioners
Practice locations: Saint Clair Shores, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559692800000",
    "number": "1629112420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19900 10 MILE ROAD",
            "address_2": "STE 102",
            "city": "ST CLAIR SHORES",
            "state": "MI",
            "postal_code": "48080",
            "telephone_number": "586-776-3366",
            "fax_number": "586-776-3369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19900 10 MILE ROAD",
            "address_2": "STE 102",
            "city": "ST CLAIR SHORES",
            "state": "MI",
            "postal_code": "48080",
            "telephone_number": "586-776-3366",
            "fax_number": "586-776-3369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED PSYCHOLOGISTS PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2019-06-05",
        "status": "A",
        "authorized_official_last_name": "BOARDWAY",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-776-3366",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Associated Psychologists PLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Associated Psychologists PLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.