Active NPI
Ethan Perry, LMHC, CASAC
- Mental Health Counselor
- Lagrangeville, NY
National Provider Identifier
1124432752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 18 004757
- Practice address
- 1133 Route 55
2ND Floor
Lagrangeville, NY 12540-5051 - Phone
- (845) 204-3436
- Fax
- (845) 298-8000
- NPI assigned
- Jun 11, 2014
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 18 004757 | NY | Primary |
Addresses
Primary practice location
1133 Route 55
2ND Floor
Lagrangeville, NY 12540-5051
Mailing address
63 Channingville Rd.
Wappingers Falls, NY 12590
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240130001864 | NY | Practitioner - Mental Health Counselor | 7911350640 | Practice locations: Wappingers Falls, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2007
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
63 Channingville Rd
Wappingers Falls, NY 12590-2338
Phone (917) 733-6009
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18 004757 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470096000000",
"number": "1124432752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "63 CHANNINGVILLE RD.",
"city": "WAPPINGERS FALLS",
"state": "NY",
"postal_code": "12590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1133 ROUTE 55",
"address_2": "2ND FLOOR",
"city": "LAGRANGEVILLE",
"state": "NY",
"postal_code": "125405051",
"telephone_number": "845-204-3436",
"fax_number": "845-298-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERRY",
"first_name": "ETHAN",
"credential": "LMHC, CASAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-11",
"last_updated": "2016-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "18 004757",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lagrangeville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2016; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.