My Family Therapy

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

10310 Issued in TX

Legal business name

MY FAMILY THERAPY

Practice address

8700 Manchaca Rd Ste 101
Austin, TX 78748-5372

Phone

(512) 853-9864

Fax

(866) 586-3938

NPI assigned

Aug 15, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Mary Anne Nericcio, PHD-CCC-SLP

Title

Speech Language Pathologist

Phone

(512) 853-9864

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1344988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344988800000",
    "number": "1902154461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 W GATE BLVD # 132-617",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787454883",
            "telephone_number": "512-853-9864",
            "fax_number": "866-586-3938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8700 MANCHACA RD STE 101",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787485372",
            "telephone_number": "512-853-9864",
            "fax_number": "866-586-3938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY FAMILY THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-15",
        "last_updated": "2012-08-15",
        "status": "A",
        "authorized_official_last_name": "NERICCIO",
        "authorized_official_first_name": "MARY ANNE",
        "authorized_official_title_or_position": "SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "512-853-9864",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD-CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "10310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "191681904",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2012; 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.