Mary Jane Gazda, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301010567 Issued in MI

Practice address

37211 Harper Ave Ste 3a
Clinton TWP, MI 48036-3001

Phone

(586) 466-7173

Fax

(586) 741-0145

NPI assigned

Oct 16, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Holly Nabozny Inc

  • Clinical Social Worker
  • Clinton TWP, MI
  • NPI 1023410131
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1639259674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37211 HARPER AVE STE 3A",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480363001",
            "telephone_number": "586-466-7173",
            "fax_number": "586-741-0145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37211 HARPER AVE STE 3A",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480363001",
            "telephone_number": "586-466-7173",
            "fax_number": "586-741-0145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAZDA",
        "first_name": "MARY",
        "middle_name": "JANE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2023-12-12",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301010567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/ BLUE SHIELD",
            "identifier": "0E04607",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret E Gavagan, PA
• Jaylen Gavie, LLP
• Gaynor Family Dental, P.C.
• Mark Albert Gaynor, D.D.S
• Paul Raymond Gaynor, D.D.S.
• Mitchell Gehrke, CRNA
• Bernadette Gendernalik, DO
• Gentle Guardians Home Care LLC
• George Nassif, M.D PLLC
• Christopher Gerhardt, DPT

• Psychologist in Clinton TWP, MI
• Providers in Clinton TWP, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.