Individual provider Active NPI

Hadley Janet O'Bryan, LMHC

  • Student in an Organized Health Care Education/Training Program
  • Waterloo, NY
National Provider Identifier
1093231045
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
31 Thurber Dr
Waterloo, NY 13165-1665
Phone
(315) 539-1980
NPI assigned
Aug 21, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary
Mental Health Counselor 101YM0800X 011665-01 NY

Addresses

Primary practice location

31 Thurber Dr
Waterloo, NY 13165-1665

Mailing address

31 Thurber Dr
Waterloo, NY 13165-1665

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240130002396 NY Practitioner - Mental Health Counselor 2365895901 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Seneca County TreasurerGroup PAC ID 7416840301, 16 clinicians

Practice addresses (Care Compare)

31 Thurber Dr
Waterloo, NY 13165-1665
Phone (315) 539-1980

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
011665-01NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Seneca County Addictions Program CurrentSince Jan 1, 2024 Accepting new patients
Seneca County Treasurer CurrentSince Jan 1, 2024 Accepting new patients

Locations

31 Thurber Dr
Waterloo, NY 13165
Phone (315) 539-1980

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1093231045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 THURBER DR",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "131651665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 THURBER DR",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "131651665",
            "telephone_number": "315-539-1980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRYAN",
        "first_name": "HADLEY",
        "middle_name": "JANET",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-21",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "011665-01",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, NY

Sources for this page

Verify at the official NPI Registry.