Active NPI
Viratri Phonrome, PSYD
- Clinical Psychologist
- Utica, NY
National Provider Identifier
1043921638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 025308
- Practice address
- 1400 Noyes St
Utica, NY 13502-3852 - Phone
- (315) 738-4439
- Fax
- (315) 738-4450
- NPI assigned
- Dec 6, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 025308 | NY | Primary |
Addresses
Primary practice location
1400 Noyes St
Utica, NY 13502-3852
Mailing address
46 Cherrywood LN
Rome, NY 13440-4772
Phone (202) 344-5718
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250923001034 | NY | Order and Referring Only - Mental Health Counselor | 7517462575 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 025308 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1670284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670284800000",
"number": "1043921638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "46 CHERRYWOOD LN",
"city": "ROME",
"state": "NY",
"postal_code": "134404772",
"telephone_number": "202-344-5718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 NOYES ST",
"city": "UTICA",
"state": "NY",
"postal_code": "135023852",
"telephone_number": "315-738-4439",
"fax_number": "315-738-4450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHONROME",
"first_name": "VIRATRI",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-12-06",
"last_updated": "2022-12-06",
"certification_date": "2022-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "025308",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Utica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.