Michelle Blose, PSYD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

35SI00757700 Issued in NJ

Practice address

2495 Shreveport Hwy
Pineville, LA 71360-4044

Phone

(318) 473-0010

NPI assigned

Sep 3, 2020

Last updated

Jan 16, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Comprehensive Psychology System PC

  dba Lifespan

  • Psychologist
  • Tinton Falls, NJ
  • NPI 1376663096
  NPD (past)

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

{
    "created_epoch": "1599091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1750995114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2495 SHREVEPORT HWY",
            "city": "PINEVILLE",
            "state": "LA",
            "postal_code": "713604044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2495 SHREVEPORT HWY",
            "city": "PINEVILLE",
            "state": "LA",
            "postal_code": "713604044",
            "telephone_number": "318-473-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOSE",
        "first_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-03",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NJ",
            "license": "35SI00757700",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "203-032",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracey Hawthorne Blackwell, BSW., CIT
• Sherry G Blackwood, MCD, CCC-SLP
• Eric Shane Blair, M.S.
• Clara Bell Blake
• Brian W. Blakewood, CRNA
• Greg H Bolton, PA-C
• Deborah L Bond, LCSW
• Chelcie Lemaire Bonin
• Janet Blank Bonnette, LCSW
• Rama Boppana

• Clinical Neuropsychologist in Pineville, LA
• Providers in Pineville, LA by specialty
• Clinical Neuropsychologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; 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.