CARMEL PSYCHOLOGICAL HEALTH, PC
Complete NPI Record 1720194335
Psychologist in Carmel, NY
Active since August 23, 2006
Complete NPI Dataset
This page contains the complete raw NPPES record for Carmel Psychological Health, Pc (NPI 1720194335), a psychologist organization in Carmel, NY. All 42 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
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Registry File Document Utilities
- NPI: 1720194335 Field 1/42
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/42
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/42
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: CARMEL PSYCHOLOGICAL HEALTH, PC Field 4/42
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: Not available Field 5/42
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 6 Field 6/42
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 4800 N SCOTTSDALE RD STE 2500 Field 7/42
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: SCOTTSDALE Field 8/42
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: AZ Field 9/42
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 852517630 Field 10/42
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/42
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 4805240990 Field 12/42
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 8456225055 Field 13/42
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 667 STONELEIGH AVE STE 202 Field 14/42
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: CARMEL Field 15/42
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: NY Field 16/42
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 105122455 Field 17/42
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/42
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 8452795908 Field 19/42
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 8456225055 Field 20/42
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: PARDO Field 23/42
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: RYAN Field 24/42
- The first name of the authorized official.
- Authorized Official Title or Position: CHIEF LEGAL OFFICER Field 25/42
- The title or position of the authorized official.
- Authorized Official Telephone Number: 2063991493 Field 26/42
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 1041C0700X Field 27/42
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 28/42
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 261Q00000X Field 29/42
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: N Field 30/42
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 3: 101YM0800X Field 31/42
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 3: N Field 32/42
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 4: 103T00000X Field 33/42
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 4: Y Field 34/42
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Other Provider Identifier 1: 05911211 Field 35/42
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 1: 05 Field 36/42
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 1: NY Field 37/42
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Is Organization Subpart: N Field 38/42
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP Field 39/42
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP Field 40/42
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP Field 41/42
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Other Organization Names 1
Additional business and trade names this provider has on file with the NPPES registry.
LifeStance Psychology Doing Business As
Name 1/1Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Secondary Practice Locations 13
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
560 White Plains Rd Ste 215
Location 1/13Tarrytown, NY 10591-5113 · Phone (914) 359-5841 · Fax (845) 622-3794
1 Executive Blvd Bsmt 1
Location 2/13Yonkers, NY 10701-6827 · Phone (845) 279-5908
1940 Commerce St Ste 309
Location 3/13Yorktown Heights, NY 10598-4449 · Phone (914) 245-0437 · Fax (914) 245-0438
1 Executive Blvd Ste 178
Location 4/13Yonkers, NY 10701-6836 · Phone (914) 595-1482 · Fax (845) 622-5055
1 Radisson Plz Fl 9
Location 5/13New Rochelle, NY 10801-5768 · Phone (914) 369-1934 · Fax (845) 622-5055
110 E 60th St Ste 706
Location 6/13New York, NY 10022-1694 · Phone (631) 323-6546 · Fax (845) 622-5055
83 3rd Ave Ste 300
Location 7/13Brooklyn, NY 11217-2315 · Phone (631) 323-6872 · Fax (845) 622-5055
733 Amsterdam Ave
Location 8/13New York, NY 10025-6330 · Phone (845) 279-5908
10 Pearl St Fl 2
Location 9/13Port Chester, NY 10573-4611 · Phone (914) 265-2762 · Fax (914) 653-8282
10 Morrissey Dr
Location 10/13Putnam Valley, NY 10579-3019 · Phone (845) 284-1570 · Fax (845) 526-7291
2510 Route 44 Ste F
Location 11/13Salt Point, NY 12578-8040 · Phone (845) 768-3178 · Fax (845) 622-3636
122 W 97TH ST, Ste 130 & 140
Location 12/13NEW YORK, NY 10025-6330 · Phone (631) 323-6580 · Fax (845) 622-5055
275 Broadhollow Rd Ste 120
Location 13/13Melville, NY 11747-4863 · Phone (845) 279-5908 · Fax (845) 622-5055
Other Provider Identifiers 1
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
05911211 Medicaid
Identifier 1/1State: NY
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
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