NIKKI A GUSTAVSON PSY.D. - NPI 1174122816 - Psychologist in Melville, NY

Q: What is Nikki Gustavson's NPI number?

The NPI number for Nikki Gustavson is 1174122816. It was assigned to this individual provider in the NPPES registry on October 23, 2020.

Q: What is Nikki Gustavson's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Nikki Gustavson was last updated on June 2, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Nikki A Gustavson Psy.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NIKKI A GUSTAVSON PSY.D. (NPI 1174122816) is an individual clinical provider in Melville, New York, licensed in New York (019182) and active in the NPI registry since October 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2009).

NPPES Registry Identity

NPI1174122816

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameNIKKI A GUSTAVSONCredential: PSY.D.

Location Address275 BROADHOLLOW RD STE 120Melville, NY 11747-4863

Mailing Address275 Broadhollow Rd Ste 120Melville, NY 11747-4863 · (845) 279-5908 · Fax (845) 622-5055

Phone(845) 279-5908

Fax(845) 622-5055

Sole ProprietorNo

Medical School CMSOtherGraduated 2009

Enumeration DateOctober 23, 2020

Last NPPES UpdateJune 2, 20262 updates tracked since enumeration

NPPES CertifiedJune 2, 2026

✔ NPI 1174122816 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in NY · 019182

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

275 BROADHOLLOW RD STE 120, Melville, NY 11747

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nikki A Gustavson Psy.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID2264904135

PECOS Enrollment IDI20260611004585

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11747 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$203.53 typical visit price

range $67.40 – $203.53

Typical copayment $50.88 (range $16.85 – $50.88)

Most-billed visit code 99205

Established Patient

$117.62 typical visit price

range $21.66 – $164.45

Typical copayment $29.40 (range $5.41 – $41.11)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.