Individual provider Active NPI

Charise Mariel Copes, PH.D.

  • Clinical Psychologist
  • Brooklyn, NY
National Provider Identifier
1144462854
Registry record updated Mar 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
011892-1 Issued in NY
Practice address
5110 12TH Ave
Brooklyn, NY 11219-3424
Phone
(800) 275-3243
Fax
(718) 854-8308
NPI assigned
Mar 26, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2009

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 011892-1 NY Primary

Addresses

Primary practice location

5110 12TH Ave
Brooklyn, NY 11219-3424

Mailing address

5110 12TH Ave
Brooklyn, NY 11219-3424
Phone (800) 275-3243

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: No
  • 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
I20090409000159 NY Practitioner - Clinical Psychologist 5890842827 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
011892NYMDMental Health Counselor
011892-1NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Knapp Street Psychiatry, PC Clinical CurrentSince Jan 1, 2019 Accepting new patients
Che Senior Psychological Services, PC Clinical CurrentSince Jan 1, 2019 Accepting new patients

Locations

5110 12th Ave
Brooklyn, NY 11219
Phone (718) 854-8370

1915 Ocean Ave
Brooklyn, NY 11230
Phone (718) 258-7700

250 Beach 17th St
Far Rockaway, NY 11691
Phone (516) 670-0212

209 Beach 125th St
Rockaway Park, NY 11694
Phone (516) 721-7625

135 Vanderbilt Ave
Staten Island, NY 10304
Phone (718) 447-0101

Organizations & group practices 2

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": "1238025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238025600000",
    "number": "1144462854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5110 12TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112193424",
            "telephone_number": "800-275-3243",
            "fax_number": "718-854-8308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5110 12TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112193424",
            "telephone_number": "800-275-3243",
            "fax_number": "718-854-8308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPES",
        "first_name": "CHARISE",
        "middle_name": "MARIEL",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-26",
        "last_updated": "2009-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "011892-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.