Active NPI
Mary Ellen Stanisci, PHD
- Psychologist
- Lincroft, NJ
National Provider Identifier
1699827501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- SI02401
- Practice address
- 654 Newman Springs Road
Lincroft, NJ 07738 - Phone
- (732) 671-0196
- Fax
- (732) 936-0404
- NPI assigned
- Jan 18, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | SI02401 | NJ | Primary |
Addresses
Primary practice location
654 Newman Springs Road
Lincroft, NJ 07738
Mailing address
13 Garryford Drive
Middletown, NJ 07748
Phone (732) 671-0196
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1302302 | Medicaid | NJ |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SI02401 | NJ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699827501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13 GARRYFORD DRIVE",
"city": "MIDDLETOWN",
"state": "NJ",
"postal_code": "07748",
"telephone_number": "732-671-0196",
"fax_number": "732-936-0404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "654 NEWMAN SPRINGS ROAD",
"city": "LINCROFT",
"state": "NJ",
"postal_code": "07738",
"telephone_number": "732-671-0196",
"fax_number": "732-936-0404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANISCI",
"first_name": "MARY ELLEN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NJ",
"license": "SI02401",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1302302",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lincroft, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.