Active NPI
Joel Wiesen, PH.D.
- Psychologist
- Scarsdale, NY
National Provider Identifier
1114417490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2066
- Practice address
- 62 Candlewood Rd
Scarsdale, NY 10583-6040 - Phone
- (617) 255-8859
- NPI assigned
- May 13, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 | 2066 | MA | Primary |
Addresses
Primary practice location
62 Candlewood Rd
Scarsdale, NY 10583-6040
Mailing address
62 Candlewood Rd
Scarsdale, NY 10583-6040
Phone (617) 255-8859
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2066 | MA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526169600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1114417490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "62 CANDLEWOOD RD",
"city": "SCARSDALE",
"state": "NY",
"postal_code": "105836040",
"telephone_number": "617-255-8859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "62 CANDLEWOOD RD",
"city": "SCARSDALE",
"state": "NY",
"postal_code": "105836040",
"telephone_number": "617-255-8859"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIESEN",
"first_name": "JOEL",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-05-13",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "2066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scarsdale, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.