Individual provider Active NPI

Elizabeth Dissin, LMHC

  • Mental Health Counselor
  • Ithaca, NY
National Provider Identifier
1134518822
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
127 W State St
Ithaca, NY 14850-5474
Phone
(607) 273-7494
NPI assigned
Jan 18, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

127 W State St
Ithaca, NY 14850-5474

Mailing address

127 W State St
Ithaca, NY 14850-5474
Phone (607) 220-4685

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240208000773 NY Practitioner - Mental Health Counselor 7810330750 Practice locations: Ithaca, NY

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2009
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

109 S Albany St
Suite 104
Ithaca, NY 14850-5482
Phone (607) 269-7904

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
007501NYMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Family and Children Services of Ithaca PastSince Aug 4, 2024 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1421539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1134518822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 W STATE ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148505474",
            "telephone_number": "607-220-4685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 W STATE ST",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148505474",
            "telephone_number": "607-273-7494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISSIN",
        "first_name": "ELIZABETH",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-18",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ithaca, NY

Sources for this page

Verify at the official NPI Registry.