COLLEEN M. PEARSON PSYD PLLC
NPI 1407308760
Psychologist in New York, NY

Active since November 02, 2016
165 BROADWAY FL 23, NEW YORK, NY 10006(917) 725-4774(917) 725-8676 Get Directions Write a Review

NPPES record last updated: June 22, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jun 22, 2021, May 21, 2021, May 6, 2021 and 3 more (6 updates tracked since 2016).

About Colleen M. Pearson Psyd Pllc NPPES

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

COLLEEN M. PEARSON PSYD PLLC (NPI 1407308760) is a healthcare organization registered as a psychologist in New York, New York and active in the NPI registry since November 2016. The organization maintains a secondary practice location in Fort Lauderdale and lists Colleen Pearson, Psychologist, as its authorized official.

NPPES Registry Identity

NPI1407308760
Entity TypeOrganization
Primary Taxonomy103T00000X
Legal Business NameCOLLEEN M. PEARSON PSYD PLLC
Location Address165 BROADWAY FL 23New York, NY 10006-1452
Mailing Address630 Victory Blvd Apt 6eStaten Island, NY 10301-3523 · (917) 725-4774 · Fax (917) 725-8676
Fax(917) 725-8676
Organization SubpartNo
Authorized OfficialColleen PearsonPsychologist · (917) 993-3975
Enumeration DateNovember 2, 2016
Last NPPES UpdateJune 22, 20216 updates tracked since enumeration
NPPES CertifiedJune 22, 2021
✔ NPI 1407308760 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License✔ Licensed in FL · PY8796
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
165 BROADWAY FL 23, New York, NY 10006

Secondary Practice Location 1

Location 12598 E Sunrise Blvd Ste 210AFort Lauderdale, FL 33304-3230 · Phone (917) 725-4774 · Fax (917) 725-8676

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Colleen M. Pearson Psyd Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by October 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateNew YorkEnrollment IDO20211018002235Non-DME Part B · Clinic/Group PracticeDue dateOctober 31, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Colleen M. Pearson Psyd PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Clinical Psychologist
NPI 1013223874
2598 E SUNRISE BLVD STE 210A
Fort Lauderdale, FL 33304
(754) 301-8739
✔ PECOS✔ Accepts Medicare1,064 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Colleen M. Pearson Psyd PLLC's NPI number?

The NPI number for Colleen M. Pearson Psyd PLLC is 1407308760. It was assigned to this organization in the NPPES registry on November 2, 2016.

Where is Colleen M. Pearson Psyd PLLC located?

Colleen M. Pearson Psyd PLLC is located at 165 Broadway Fl 23, New York, NY 10006. The listed phone number is (917) 725-4774.

What is Colleen M. Pearson Psyd PLLC's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Colleen M. Pearson Psyd PLLC enrolled in Medicare?

Yes. Colleen M. Pearson Psyd PLLC is registered in the Medicare PECOS enrollment system.

When is Colleen M. Pearson Psyd PLLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (New York, Clinic/Group Practice) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Colleen M. Pearson Psyd PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Colleen M. Pearson Psyd PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Colleen M. Pearson Psyd PLLC was last updated on June 22, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.