Active NPI
Maryjo Gavin, PHD
- Clinical Psychologist
- Toledo, OH
National Provider Identifier
1871612770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- P.4227
- Practice address
- 3125 Transverse Dr
Toledo, OH 43614 - Phone
- (419) 383-5695
- Fax
- (419) 383-3031
- NPI assigned
- Mar 29, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 6301011920 | MI | |
| Clinical Psychologist | 103TC0700X | P.4227 | OH | Primary |
Addresses
Primary practice location
3125 Transverse Dr
Toledo, OH 43614
Mailing address
3355 Glendale Ave FL 3
Toledo, OH 43614-2426
Phone (419) 383-5695
Other practice location 1
6071 W Outer Dr
Detroit, MI 48235-2624
Phone (313) 966-3300 ext. 09117
Other practice location 2
6071 W Outer Dr
Detroit, MI 48235-2624
Phone (313) 966-3300 ext. 09117
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301011920 | MI | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552003200000",
"number": "1871612770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3355 GLENDALE AVE FL 3",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436142426",
"telephone_number": "419-383-5695",
"fax_number": "419-383-3031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3125 TRANSVERSE DR",
"city": "TOLEDO",
"state": "OH",
"postal_code": "43614",
"telephone_number": "419-383-5695",
"fax_number": "419-383-3031"
}
],
"practiceLocations": [
{
"address_1": "6071 W Outer Dr",
"address_purpose": "LOCATION",
"city": "Detroit",
"state": "MI",
"postal_code": "482352624",
"country_code": "US",
"telephone_number": "313-966-3300 x09117",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6071 W Outer Dr",
"address_purpose": "LOCATION",
"city": "Detroit",
"state": "MI",
"postal_code": "482352624",
"country_code": "US",
"telephone_number": "313-966-3300 x09117",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GAVIN",
"first_name": "MARYJO",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-29",
"last_updated": "2019-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MI",
"license": "6301011920",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "P.4227",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Toledo, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.