Active NPI
Emily Upshur, PH.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1083039382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 019571
- Practice address
- 250 Park Ave Ste 7081
New York, NY 10177-0001 - Phone
- (917) 830-5324
- NPI assigned
- Feb 23, 2014
- Last updated
- Jul 28, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | 019571 | NY | Primary |
Addresses
Primary practice location
250 Park Ave Ste 7081
New York, NY 10177-0001
Mailing address
629 Fifth Ave Ste 109
Pelham, NY 10803-3708
Phone (917) 830-5324
Other practice location 1
629 Fifth Ave Ste 109
Pelham, NY 10803-3708
Phone (917) 830-5324
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2024 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019571 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627430400000",
"number": "1083039382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "629 FIFTH AVE STE 109",
"city": "PELHAM",
"state": "NY",
"postal_code": "108033708",
"telephone_number": "917-830-5324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 PARK AVE STE 7081",
"city": "NEW YORK",
"state": "NY",
"postal_code": "101770001",
"telephone_number": "917-830-5324"
}
],
"practiceLocations": [
{
"address_1": "629 Fifth Ave Ste 109",
"address_purpose": "LOCATION",
"city": "Pelham",
"state": "NY",
"postal_code": "108033708",
"country_code": "US",
"telephone_number": "917-830-5324",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "UPSHUR",
"first_name": "EMILY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-02-23",
"last_updated": "2021-07-28",
"certification_date": "2021-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "019571",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.