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DR. ETTALEE SAMEK PASS PH.D.
NPI 1275576241
Psychologist - Clinical in Smithtown, NY

Active since June 14, 2006Opted out of Medicare · through Mar 1, 2028
29 MANOR RD, SMITHTOWN, NY 11787(631) 265-8873(631) 751-5287 Get Directions Write a Review

NPPES record last updated: February 7, 2010. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Ettalee Samek Pass Ph.d. NPPES

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

DR. ETTALEE SAMEK PASS PH.D. (NPI 1275576241) is an individual clinical provider in Smithtown, New York, licensed in New York (011597) and active in the NPI registry since June 2006. She has opted out of Medicare through March 1, 2028.

NPPES Registry Identity

NPI1275576241
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameDR. ETTALEE SAMEK PASSCredential: PH.D.
Location Address29 MANOR RDSmithtown, NY 11787-2714
Mailing Address29 Manor RdSmithtown, NY 11787-2752 · (631) 265-8873 · Fax (631) 751-5287
Phone(631) 265-8873
Fax(631) 751-5287
Sole ProprietorYes
Enumeration DateJune 14, 2006
Last NPPES UpdateFebruary 7, 2010
✔ NPI 1275576241 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 · 011597
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.
29 MANOR RD, Smithtown, NY 11787
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Other Identifiers 1

Medicare ID-Type UnspecifiedV01201NY

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Ettalee Samek Pass Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 1, 2020 through March 1, 2028.

Opt-Out Effective DateMarch 1, 2020
Opt-Out In Effect ThroughMarch 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DEV R CHITKARA M.D. P.C.
Otolaryngology
29 MANOR RD
SMITHTOWN, NY 11787
Suffolk County (631) 979-0311
DR. DEV R CHITKARA MD
Otolaryngology
29 MANOR RD
SMITHTOWN, NY 11787
Suffolk County (631) 979-0311

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ettalee Pass's NPI number?

The NPI number for Ettalee Pass is 1275576241. It was assigned to this individual provider in the NPPES registry on June 14, 2006.

Where is Ettalee Pass located?

Ettalee Pass practices at 29 Manor Rd, Smithtown, NY 11787. The listed phone number is (631) 265-8873.

What is Ettalee Pass's specialty?

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

Is Ettalee Pass enrolled in Medicare?

No. Ettalee Pass has opted out of Medicare through March 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Ettalee Pass was last updated on February 7, 2010. NPI Profile syncs with the weekly NPPES data releases published by CMS.