Individual provider Active NPI

Alyssa Bohonan

  • Mental Health Counselor
  • Islandia, NY
National Provider Identifier
1023699006
Registry record updated Apr 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
009109 Issued in NY
Practice address
1777 Veterans Memorial Hwy Ste 14
Islandia, NY 11749-1555
Phone
(631) 630-6439
NPI assigned
Apr 20, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 009109 NY Primary

Addresses

Primary practice location

1777 Veterans Memorial Hwy Ste 14
Islandia, NY 11749-1555

Mailing address

58 Pitchpine PL
Medford, NY 11763-4226

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260212002471 NY Practitioner - Mental Health Counselor 4688154388 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2017
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4 Paddock LN
Medford, NY 11763-4098

99 Rochester Ave
East Atlantic Beach, NY 11561-1032

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Tina Flanagan Licensed Mental Health Counselor P.C. CurrentSince Jan 5, 2026 Accepting new patients

Locations

1777 Veterans Memorial Hwy
Ste 14
Islandia, NY 11749
Phone (631) 212-2405

94 Medford Ave
Patchogue, NY 11772
Phone (631) 213-9882

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1023699006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 PITCHPINE PL",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117634226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 VETERANS MEMORIAL HWY STE 14",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117491555",
            "telephone_number": "631-630-6439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOHONAN",
        "first_name": "ALYSSA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-20",
        "last_updated": "2021-04-20",
        "certification_date": "2020-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "009109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Islandia, NY

Sources for this page

Verify at the official NPI Registry.