Organization Active NPI

Private Practice Psychiatry Services LLC

  • Counselor
  • Riverhead, NY
National Provider Identifier
1043869464
Registry record updated Sep 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
PRIVATE PRACTICE PSYCHIATRY SERVICES LLC
Practice address
67 E Main St
Riverhead, NY 11901-2422
Phone
(631) 392-4357
Fax
(631) 392-4358
NPI assigned
Sep 9, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2019

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

Authorized official

Name
Ms. Deborah Petry, LCSW-R
Title
Counselor
Phone
(631) 392-4357

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X Primary

Addresses

Primary practice location

67 E Main St
Riverhead, NY 11901-2422

Mailing address

67 E Main St
Riverhead, NY 11901-2422

Other identifiers 1

IdentifierTypeStateIssuer
1497856108OtherNYCOMMERICAL

National Provider Directory

National Provider Directory

Locations

67 E Main St
Riverhead, NY 11901
Phone (631) 392-4357

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1567987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567987200000",
    "number": "1043869464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 E MAIN ST",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012422",
            "fax_number": "631-392-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 E MAIN ST",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012422",
            "telephone_number": "631-392-4357",
            "fax_number": "631-392-4358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVATE PRACTICE PSYCHIATRY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-09",
        "last_updated": "2019-09-09",
        "status": "A",
        "authorized_official_last_name": "PETRY",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "COUNSELOR",
        "authorized_official_telephone_number": "631-392-4357",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW-R"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERICAL",
            "identifier": "1497856108",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverhead, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2019; 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.