Jacqueline Shall-McCumiskey, Psy.D. Mindful Practice

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

JACQUELINE SHALL-MCCUMISKEY, PSY.D. MINDFUL PRACTICE

Doing business as

Jacqueline Shall-McCumiskey, Psy.D., PLLC

Practice address

1675 Richmond Rd
Staten Island, NY 10304-2317

Phone

(646) 479-8068

NPI assigned

Nov 3, 2023

Last updated

Mar 3, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

1104699974As reported in NPPES

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

Authorized official

Name

Jacqueline Shall-McCumiskeyNPI 1083160170

Title

Owner

Phone

(646) 479-8068

Specialties & licenses 1

Addresses

Other names 2

• JACQUELINE SHALL-MCCUMISKEY, PSY.D., PLLC Doing business as
• JACQUELINE SHALL-MCCUMISKEY, PSY.D. Mindful Practice Other name

Part of

Jacqueline Shall-McCumiskey PSYD Mindful Practice

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jacqueline Shall-McCumiskey, PSY. D.

  • Clinical Psychologist
  • Marlton, NJ
  • NPI 1083160170
  NPD Authorized official

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

{
    "created_epoch": "1698969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740960000000",
    "number": "1104699974",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 RICHMOND RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103042317",
            "telephone_number": "646-479-8068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACQUELINE SHALL-MCCUMISKEY, PSY.D. MINDFUL PRACTICE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "1104699974",
        "enumeration_date": "2023-11-03",
        "last_updated": "2025-03-03",
        "certification_date": "2025-02-06",
        "status": "A",
        "authorized_official_last_name": "SHALL-MCCUMISKEY",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "646-479-8068"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JACQUELINE SHALL-MCCUMISKEY, PSY.D., PLLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JACQUELINE SHALL-MCCUMISKEY, PSY.D., PLLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JACQUELINE SHALL-MCCUMISKEY, PSY.D. Mindful Practice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jessica Jacobs
• Debra Jacobson, M.A. SPED
• Erin Meade Jacobson, OTR/L
• Esther Sharon Jacobson, LCSW
• Esther Jacoby, MS CCC-SLP
• Angnieszka Jaczynski, RN
• Ali Jaddoa
• Mumtaz Jafri, MD
• Bahram Jahanbakhsh, M.D.
• Keyvan Jahanbakhsh, MD

• Psychologist in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; 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.