Jacqueline Shall-McCumiskey, PSY. D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

021797 Issued in NY

Practice address

525 Route 73 N Ste 104
Marlton, NJ 08053-3422

Phone

(646) 479-8068

NPI assigned

Aug 29, 2016

Last updated

Sep 29, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, NJ2 enrollments

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 2

Specialty

Clinical Psychologist

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Go Mindful Practice, LLC

  • Cognitive & Behavioral Psychologist
  • Marlton, NJ
  • NPI 1508580937
  Medicare reassignment NPD Authorized official
• Cognitive Therapy If Si Pysch SVCS & Lic Mental Health Counselor PLLC

  • Psychologist
  • Staten Island, NY
  • NPI 1437451689
  Medicare reassignment NPD
• Jacqueline Shall-McCumiskey, Psy.D. Mindful Practice

  dba Jacqueline Shall-McCumiskey, Psy.D., PLLC

  • Psychologist
  • Staten Island, NY
  • NPI 1104699974
  NPD Authorized official

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

{
    "created_epoch": "1472428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1083160170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 RICHMOND RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103042317",
            "telephone_number": "646-479-8068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 ROUTE 73 N STE 104",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533422",
            "telephone_number": "646-479-8068"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1110 South Ave",
            "address_2": "Suite 5",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103143403",
            "country_code": "US",
            "telephone_number": "347-273-1290",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1675 Richmond Rd",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103042317",
            "country_code": "US",
            "telephone_number": "646-479-8068",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHALL-MCCUMISKEY",
        "first_name": "JACQUELINE",
        "name_prefix": "Dr.",
        "credential": "PSY. D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-29",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "021797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hetal S Shah, M.D.
• Sarah J Shah, DNP, APN, A-GNP-C
• Tarak Shah, D.D.S.
• Yash Shah
• Zuhra Shah, PA-C
• Maasi Shamilov, MD
• Jessica Sharifi-Azad, RPA-C
• Nicolette Marie Sheehan
• Hameed A Sheikh, MD
• Seema Shekar, DO

• Clinical Psychologist in Marlton, NJ
• Providers in Marlton, NJ by specialty
• Clinical Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.