Mary Nowack, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301003862 Issued in MI

Practice address

4747 Woodcraft Rd
Okemos, MI 48864-2070

Phone

(517) 332-1580

NPI assigned

Apr 24, 2007

Last updated

May 15, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Michigan State University College of Human Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1831318203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4747 WOODCRAFT RD",
            "city": "OKEMOS",
            "state": "MI",
            "postal_code": "488642070",
            "telephone_number": "517-332-1580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 WOODCRAFT RD",
            "city": "OKEMOS",
            "state": "MI",
            "postal_code": "488642070",
            "telephone_number": "517-332-1580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOWACK",
        "first_name": "MARY",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-24",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301003862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ezio Novelli, DDS, MD
• Gerald Vincent Nowinski, DDS
• Douglas Nunn, D.O.
• Joella Ochaba
• Frank Martin Ochberg, MD
• Kaytie Lynne Ochenkowski, LMSW

• Clinical Psychologist in Okemos, MI
• Providers in Okemos, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.