Individual provider Active NPI

Andy Lopez-Williams, PHD

  • Clinical Psychologist
  • Utica, NY
National Provider Identifier
1144276940
Registry record updated May 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
017312 Issued in NY
Practice address
122 Business Park Dr
Suite 1
Utica, NY 13502-6321
Phone
(315) 732-3431
Fax
(866) 822-2343
NPI assigned
May 25, 2006
Last updated
May 17, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 17, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 017312 NY Primary

Addresses

Primary practice location

122 Business Park Dr
Suite 1
Utica, NY 13502-6321

Mailing address

122 Business Park Dr
Suite 1
Utica, NY 13502-6321
Phone (315) 732-3431

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
I20111116000126 NY Practitioner - Clinical Psychologist 4880699362 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
017312NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
ADHD & Autism Psychological Services and Advocacy, PLLC Past Accepting new patients
Lifespan Physician Group, Inc. Past Accepting new patients

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463443200000",
    "number": "1144276940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 BUSINESS PARK DR",
            "address_2": "SUITE 1",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135026321",
            "telephone_number": "315-732-3431",
            "fax_number": "866-822-2343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 BUSINESS PARK DR",
            "address_2": "SUITE 1",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135026321",
            "telephone_number": "315-732-3431",
            "fax_number": "866-822-2343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ-WILLIAMS",
        "first_name": "ANDY",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2016-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "017312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Utica, NY

Sources for this page

Verify at the official NPI Registry.