NPIMap

Organization Active NPI

Queens Cognitive Behavioral Therapy Psychology, PLLC

  • Psychologist
  • Flushing, NY
National Provider Identifier
1104356195
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
019732 Issued in NY
Legal business name
QUEENS COGNITIVE BEHAVIORAL THERAPY PSYCHOLOGY, PLLC
Practice address
14108 Jewel Ave
Flushing, NY 11367-1618
Phone
(347) 815-4228
Fax
(347) 402-8186
NPI assigned
Jun 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Benjamin Zvi Grysman, PH.D.
Title
Owner/Director
Phone
(347) 815-4228

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 003047 NY
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 019732 NY Primary

Addresses

Primary practice location

14108 Jewel Ave
Flushing, NY 11367-1618

Mailing address

14108 Jewel Ave
Flushing, NY 11367-1618
Phone (347) 815-4228

Other identifiers 1

IdentifierTypeStateIssuer
P5268379OtherNYUNITED HEALTH CARE OXFORD

Other names 1

  • Queens CBT Center Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1497312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1104356195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14108 JEWEL AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113671618",
            "telephone_number": "347-815-4228",
            "fax_number": "347-402-8186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14108 JEWEL AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113671618",
            "telephone_number": "347-815-4228",
            "fax_number": "347-402-8186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEENS COGNITIVE BEHAVIORAL THERAPY PSYCHOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GRYSMAN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "ZVI",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "347-815-4228",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "003047",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "NY",
            "license": "019732",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE OXFORD",
            "identifier": "P5268379",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Queens CBT Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Queens CBT Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 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.