Active NPI
Manuel Marichal
- Clinical Child & Adolescent Psychologist
- Jacksonville, FL
National Provider Identifier
1639059389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- Practice address
- 10140 Centurion Pkwy N
Jacksonville, FL 32256-0532 - Phone
- (904) 697-4100
- Fax
- (904) 697-5102
- NPI assigned
- Sep 4, 2025
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | Primary |
Addresses
Primary practice location
10140 Centurion Pkwy N
Jacksonville, FL 32256-0532
Mailing address
10140 Centurion Pkwy N
Jacksonville, FL 32256-0532
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1756944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756944000000",
"number": "1639059389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10140 CENTURION PKWY N",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322560532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10140 CENTURION PKWY N",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322560532",
"telephone_number": "904-697-4100",
"fax_number": "904-697-5102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARICHAL",
"first_name": "MANUEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-09-04",
"last_updated": "2025-09-04",
"certification_date": "2025-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.