Active NPI
David Clinton, PH.D.
- Psychologist
- Mount Airy, MD
National Provider Identifier
1750816575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 05765
- Practice address
- 1311 S Main St
Suite 202
Mount Airy, MD 21771-5447 - Phone
- (301) 829-2242
- NPI assigned
- Apr 30, 2017
- Last updated
- Apr 30, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 05765 | MD | Primary |
| Clinical Psychologist | 103TC0700X | 05765 | MD | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 05765 | MD | |
| Family Psychologist | 103TF0000X | 05765 | MD | |
| Group Psychotherapy Psychologist | 103TP2701X | 05765 | MD |
Addresses
Primary practice location
1311 S Main St
Suite 202
Mount Airy, MD 21771-5447
Mailing address
1311 S Main St
Suite 202
Mount Airy, MD 21771-5447
Phone (301) 829-2242
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 |
|---|---|---|---|
| 05765 | MD | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493510400000",
"number": "1750816575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1311 S MAIN ST",
"address_2": "SUITE 202",
"city": "MOUNT AIRY",
"state": "MD",
"postal_code": "217715447",
"telephone_number": "301-829-2242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1311 S MAIN ST",
"address_2": "SUITE 202",
"city": "MOUNT AIRY",
"state": "MD",
"postal_code": "217715447",
"telephone_number": "301-829-2242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLINTON",
"first_name": "DAVID",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-04-30",
"last_updated": "2017-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MD",
"license": "05765",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "05765",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MD",
"license": "05765",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "MD",
"license": "05765",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "MD",
"license": "05765",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Airy, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.