Dr. Gary R Livermore, PhD
Psychologist in Minneapolis, MN. Individual provider (NPI-1).
NPI number1790741486
StatusActive
Last updated in NPPESJul 13, 2026
Details
- NPI
- 1790741486
- Entity type
- Individual (NPI-1)
- Name
- Dr. Gary R Livermore
- Credential
- PhD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 22, 2006
- Last updated
- Jul 13, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103T00000X | Psychologist | LP2236 | MN | Yes |
Practice location
322 West 50th StreetMinneapolis, MN 55419
Phone 612-821-8489
Mailing address
322 West 50th StreetMinneapolis, MN 55419
Phone 612-821-8489
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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