Evergreen Mental Health & Assessment, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

EVERGREEN MENTAL HEALTH & ASSESSMENT, LLC

Practice address

4758 Lynnville Way
Clay, NY 13041-8990

Phone

(240) 274-0012

NPI assigned

Dec 21, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Alexander Joseph Hinnebusch, PH.D.NPI 1184124901

Title

Owner

Phone

(240) 274-0012

Specialties & licenses 2

Addresses

Practitioners 1

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

• Alexander Joseph Hinnebusch, PH.D.

  • Clinical Psychologist
  • Clay, NY
  • NPI 1184124901
  NPD Authorized official

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

{
    "created_epoch": "1671580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671580800000",
    "number": "1073225090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4758 LYNNVILLE WAY",
            "city": "CLAY",
            "state": "NY",
            "postal_code": "130418990",
            "telephone_number": "240-274-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4758 LYNNVILLE WAY",
            "city": "CLAY",
            "state": "NY",
            "postal_code": "130418990",
            "telephone_number": "240-274-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MENTAL HEALTH & ASSESSMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-21",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A",
        "authorized_official_last_name": "HINNEBUSCH",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-274-0012",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicki Delvecchio, RD, CDN
• Erika L Demarche, PMHNP
• Rebecca Lenore Domroe, LCSW
• Tina M Drake, RN
• Heather Lynne Dufresne, LMSW
• Donna Louise Fifield, LICENSED PRACTICAL N
• Wendy Donna Flint, COTA
• Julianne Mary Francey, RN
• Sue P Gardner, LCSW
• Sara Elizabeth Gordon, PTA

• Clinical Psychologist in Clay, NY
• Providers in Clay, 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 Dec 21, 2022; 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.