Individual provider Active NPI

Tia R Dole, PH.D.

  • Psychologist
  • New York, NY
National Provider Identifier
1134465578
Registry record updated Dec 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
019906 Issued in NY
Practice address
411 W. 114TH Street
Suite 4 a/B
New York, NY 10025
Phone
(212) 523-4061
Fax
(212) 523-4911
NPI assigned
Dec 12, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 019906 NY Primary

Addresses

Primary practice location

411 W. 114TH Street
Suite 4 a/B
New York, NY 10025

Mailing address

411 W. 114TH Street
Suite 4 a/B
New York, NY 10025
Phone (212) 523-4061

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

LicenseStateTypeSpecialty
019906NYMDPsychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355270400000",
    "number": "1134465578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 W. 114TH STREET",
            "address_2": "SUITE 4 A/B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10025",
            "telephone_number": "212-523-4061",
            "fax_number": "212-523-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 W. 114TH STREET",
            "address_2": "SUITE 4 A/B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10025",
            "telephone_number": "212-523-4061",
            "fax_number": "212-523-4911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOLE",
        "first_name": "TIA",
        "middle_name": "R",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-12",
        "last_updated": "2012-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "019906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.