Active NPI
Diana Ballard, PHD
- Pastoral Counselor
- Staten Island, NY
National Provider Identifier
1114465564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pastoral Counselor
- License
- BCCC#0557
- Practice address
- 510 Travis Ave
Staten Island, NY 10314-6154 - Phone
- (917) 763-2476
- Fax
- (718) 370-3534
- NPI assigned
- Feb 6, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pastoral Counselor | 101YP1600X | BCCC#0557 | NY | Primary |
Addresses
Primary practice location
510 Travis Ave
Staten Island, NY 10314-6154
Mailing address
510 Travis Ave
Staten Island, NY 10314-6154
Phone (917) 763-2476
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 |
|---|---|---|---|
| BCCC#0557 | NY | MD | Pastoral Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492732800000",
"number": "1114465564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 TRAVIS AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103146154",
"telephone_number": "917-763-2476",
"fax_number": "718-370-3534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 TRAVIS AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103146154",
"telephone_number": "917-763-2476",
"fax_number": "718-370-3534"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLARD",
"first_name": "DIANA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-02-06",
"last_updated": "2017-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP1600X",
"taxonomy_group": "",
"desc": "Counselor, Pastoral",
"state": "NY",
"license": "BCCC#0557",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.