Mary Anne Boudin, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1051 Issued in WA

Practice address

3900 E Valley Rd
Suite 100
Renton, WA 98057-4954

Phone

(425) 251-0698

Fax

(425) 251-8974

NPI assigned

Oct 14, 2006

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

Other identifiers 2

Other names 1

• Dr. Mary Anne Lloyd Professional name

Medicare fee-for-service enrollment

Enrolled in WA

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

Other, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

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": "1160784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458432000000",
    "number": "1932299294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 E VALLEY RD",
            "address_2": "SUITE 100",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574954",
            "telephone_number": "425-251-0698",
            "fax_number": "425-251-8974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 E VALLEY RD",
            "address_2": "SUITE 100",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574954",
            "telephone_number": "425-251-0698",
            "fax_number": "425-251-8974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDIN",
        "first_name": "MARY ANNE",
        "name_prefix": "Ms.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-14",
        "last_updated": "2016-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "1051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "1051",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "G8881323",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY ANNE",
            "last_name": "LLOYD",
            "prefix": "DR.",
            "credential": "PHD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Michael Scott Bostick, R.PH.
• Leon Kinley Boston
• Margaretha Johanna Botes Parker, RN
• Jillian M Boucek, LMP
• Henry M Boudin, PHD
• Laurel A Boulds-Fisk, LMP
• Mark L Bowers, P.A.
• Aletha G Bowman, OT
• Sarah L Boyd, OT
• Jeffrey Boyle, PT

• Clinical Psychologist in Renton, WA
• Providers in Renton, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2016; 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.