Individual provider Active NPI

Richard E Carr, PSYD

  • Clinical Psychologist
  • Brooklyn, NY
National Provider Identifier
1104904499
Registry record updated Aug 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
010456-1 Issued in NY
Practice address
3512 Quentin Rd Ste 110
Brooklyn, NY 11234-4245
Phone
(718) 942-6595
NPI assigned
Nov 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 35SI00312100 NJ
Clinical Psychologist 103TC0700X 010456-1 NY Primary

Addresses

Primary practice location

3512 Quentin Rd Ste 110
Brooklyn, NY 11234-4245

Mailing address

3512 Quentin Rd Ste 110
Brooklyn, NY 11234-4245
Phone (718) 942-6595

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
I20190913001526 NY Practitioner - Clinical Psychologist 7810920543 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
35SI00312100NJMDPsychologist
010456-1NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Senior Care Therapy Psychology of New York PLLC Psychologist CurrentSince Jul 23, 2021 Accepting new patients
Rutgers Health - Behavioral Health Past Accepting new patients

Locations

2719 Hollywood Blvd
Hollywood, FL 33020
Phone (954) 354-2555

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": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566864000000",
    "number": "1104904499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3512 QUENTIN RD STE 110",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112344245",
            "telephone_number": "718-942-6595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3512 QUENTIN RD STE 110",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112344245",
            "telephone_number": "718-942-6595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARR",
        "first_name": "RICHARD",
        "middle_name": "E",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2019-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NJ",
            "license": "35SI00312100",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "010456-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.