Active NPI
Kristin Joy Carothers, PH.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1093024283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 020024-1
- Practice address
- 308 West 140TH Street
#4
New York, NY 10030 - Phone
- (347) 879-0737
- NPI assigned
- Oct 5, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 020024-1 | NY | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 020024 | NY |
Addresses
Primary practice location
308 West 140TH Street
#4
New York, NY 10030
Mailing address
3959 Broadway, 6TH FL North
Pediatric Psychiatry School Based Mental Health
New York, NY 10030
Phone (773) 307-5572
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020024-1 | NY | MD | Physical Medicine & Rehabilitation Physician |
| 020024 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380585600000",
"number": "1093024283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3959 BROADWAY, 6TH FL NORTH",
"address_2": "PEDIATRIC PSYCHIATRY SCHOOL BASED MENTAL HEALTH",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10030",
"telephone_number": "773-307-5572"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 WEST 140TH STREET",
"address_2": "#4",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10030",
"telephone_number": "347-879-0737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAROTHERS",
"first_name": "KRISTIN",
"middle_name": "JOY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-10-05",
"last_updated": "2013-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "020024-1",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NY",
"license": "020024",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2013; 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.