NPIMap

Organization Active NPI

Main Street Clinical Associates, PA

  • Psychologist
  • Durham, NC
National Provider Identifier
1922035260
Registry record updated Jul 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
MAIN STREET CLINICAL ASSOCIATES, PA
Practice address
3326 Durham Chapel Hill Blvd.
BLDG. C, Suite 230
Durham, NC 27707-2600
Phone
(919) 286-3453
Fax
(919) 286-7033
NPI assigned
Jun 26, 2006
Last updated
Jul 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2019

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

Authorized official

Name
Shannon Van Wey, PHD
Title
Treasurer
Phone
(919) 286-3453

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X

Addresses

Primary practice location

3326 Durham Chapel Hill Blvd.
BLDG. C, Suite 230
Durham, NC 27707-2600

Mailing address

3326 Durham Chapel Hill Blvd.
BLDG. C, Suite 230
Durham, NC 27707-2600
Phone (919) 286-3453

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040428001210 NC Part B Supplier - Clinic/Group Practice 8123015435 Receives reassigned benefits from 5 practitioners
Practice locations: Durham, NC

National Provider Directory

National Provider Directory

Locations

115 N Duke St
Ste 1B
Durham, NC 27701
Phone (919) 286-3453

2020 W Main St
Ste 301
Durham, NC 27705
Phone (919) 286-3453

2828 Pickett Rd
Ste 250B
Durham, NC 27705
Phone (919) 286-3453

3326 Durham Chapel Hill Blvd
Bldg C
Durham, NC 27707
Phone (919) 286-3453

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562803200000",
    "number": "1922035260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3326 DURHAM CHAPEL HILL BLVD.",
            "address_2": "BLDG. C, SUITE 230",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072600",
            "telephone_number": "919-286-3453",
            "fax_number": "919-286-7033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3326 DURHAM CHAPEL HILL BLVD.",
            "address_2": "BLDG. C, SUITE 230",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072600",
            "telephone_number": "919-286-3453",
            "fax_number": "919-286-7033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET CLINICAL ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2019-07-11",
        "status": "A",
        "authorized_official_last_name": "VAN WEY",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "919-286-3453",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.