Active NPI
Angeliqua Mitra, PSY.D.
- Psychologist
- Huntington, NY
National Provider Identifier
1114350733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 55 Horizon Dr
Huntington, NY 11743-4436 - Phone
- (631) 920-8004
- NPI assigned
- Aug 19, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
55 Horizon Dr
Huntington, NY 11743-4436
Mailing address
16 Winchester Dr
Glen Head, NY 11545-3203
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 022321 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376870400000",
"number": "1114350733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 WINCHESTER DR",
"city": "GLEN HEAD",
"state": "NY",
"postal_code": "115453203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 HORIZON DR",
"city": "HUNTINGTON",
"state": "NY",
"postal_code": "117434436",
"telephone_number": "631-920-8004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITRA",
"first_name": "ANGELIQUA",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-19",
"last_updated": "2013-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntington, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.