Laurel Jarvis, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810002101 Issued in VA

Practice address

11050 Mount Belvedere Blvd
Behavioral Health Department, Meddac
Fort Drum, NY 13602-5438

Phone

(315) 772-4850

NPI assigned

Jun 1, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Laurel Shuster Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Interoperability endpoints

• Direct secure messaging: laurel.jarvis.1@30520.direct.athenahealth.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1003100512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15980 COUNTY ROUTE 181",
            "city": "CLAYTON",
            "state": "NY",
            "postal_code": "136243108",
            "telephone_number": "202-270-8988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 MOUNT BELVEDERE BLVD",
            "address_2": "BEHAVIORAL HEALTH DEPARTMENT, MEDDAC",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025438",
            "telephone_number": "315-772-4850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JARVIS",
        "first_name": "LAUREL",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-01",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "025329",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810002101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAUREL",
            "last_name": "SHUSTER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michelle Kathleen House, PHARMD
• Denise Huerta, NPP
• Michael Hunt, PA-C
• Matthew Tyler Hunter, DO
• Paula Jank
• Brooke A. Jensen
• Joseph Johnson, DPT
• Kristine Elizabeth Johnson, ATC
• Melissa H Johnson, DDS
• Wayne Michael Johnson, PTA, CCI

• Clinical Psychologist in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.