Active NPI
Samantha Bryn Mackson, PSYD
- Psychologist
- Pinecrest, FL
National Provider Identifier
1699443317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY11220
- Practice address
- 10205 S Dixie Hwy Ste 203
Pinecrest, FL 33156-3168 - Phone
- (305) 662-2686
- NPI assigned
- Aug 30, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY11220 | FL | Primary |
Addresses
Primary practice location
10205 S Dixie Hwy Ste 203
Pinecrest, FL 33156-3168
Mailing address
413 E Palmetto Park Rd Apt 443
Boca Raton, FL 33432-5185
Phone (954) 600-5405
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY11220 | FL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630281600000",
"number": "1699443317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "413 E PALMETTO PARK RD APT 443",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334325185",
"telephone_number": "954-600-5405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10205 S DIXIE HWY STE 203",
"city": "PINECREST",
"state": "FL",
"postal_code": "331563168",
"telephone_number": "305-662-2686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKSON",
"first_name": "SAMANTHA",
"middle_name": "BRYN",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-30",
"last_updated": "2021-08-30",
"certification_date": "2021-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "PY11220",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pinecrest, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.