Active NPI
Nicholas Mitrani, LPE-I
- Clinical Psychologist
- Conway, AR
National Provider Identifier
1629426770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 18-22P
- Practice address
- 4206 Prince Street
Conway, AR 72034-9398 - Phone
- (501) 932-0255
- NPI assigned
- May 31, 2016
- Last updated
- Jul 24, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 18-22P | AR | |
| Counseling Psychologist | 103TC1900X | 18-22P | AR | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 18-22P | AR | |
| Clinical Psychologist | 103TC0700X | 18-22P | AR | Primary |
Addresses
Primary practice location
4206 Prince Street
Conway, AR 72034-9398
Mailing address
4206 Prince Street
Conway, AR 72034-9398
Phone (501) 932-0255
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 232944719 | Medicaid | AR |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18-22P | AR | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Conway Psychological Assessment Center | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Psychologist
- Conway, AR
- NPI 1255697330
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563926400000",
"number": "1629426770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4206 PRINCE STREET",
"city": "CONWAY",
"state": "AR",
"postal_code": "720349398",
"telephone_number": "501-932-0255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4206 PRINCE STREET",
"city": "CONWAY",
"state": "AR",
"postal_code": "720349398",
"telephone_number": "501-932-0255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITRANI",
"first_name": "NICHOLAS",
"credential": "LPE-I",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-31",
"last_updated": "2019-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AR",
"license": "18-22P",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "AR",
"license": "18-22P",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "AR",
"license": "18-22P",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AR",
"license": "18-22P",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "232944719",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conway, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.