Rochester Center for Autism, Inc

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

LP0911 Issued in MN

Legal business name

ROCHESTER CENTER FOR AUTISM, INC

Practice address

1220 4TH Ave SW
Rochester, MN 55902-3834

Phone

(507) 424-3234

Fax

(507) 424-3235

NPI assigned

Oct 27, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Mandy Marie Eggert

Title

Director/Program Supervisor

Phone

(507) 424-3234

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730179995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 4TH AVE SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559023834",
            "telephone_number": "507-424-3234",
            "fax_number": "507-424-3235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 4TH AVE SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559023834",
            "telephone_number": "507-424-3234",
            "fax_number": "507-424-3235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCHESTER CENTER FOR AUTISM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EGGERT",
        "authorized_official_first_name": "MANDY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "DIRECTOR/PROGRAM SUPERVISOR",
        "authorized_official_telephone_number": "507-424-3234",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MN",
            "license": "LP0911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN PROVIDER #",
            "identifier": "265K2RO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Cognitive & Behavioral Psychologist in Rochester, MN
• Providers in Rochester, MN by specialty
• Cognitive & Behavioral Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.