Jaclyn Spiegel, PSY.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

019721 Issued in NY

Practice address

1428 5TH Ave
Bay Shore, NY 11706-4147

Phone

(631) 665-1900

NPI assigned

Jul 5, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Acld Kramer Learning Center

  • Developmental Disabilities Clinic/Center
  • Bay Shore, NY
  • NPI 1942565015
  NPD (past)
• Adults and Children With Learning and Developmental Disabilites, Inc.

  • Developmental Disabilities Clinic/Center
  • Bethpage, NY
  • NPI 1265674303
  NPD (past)

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

{
    "created_epoch": "1309824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442534400000",
    "number": "1154618635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1912 TANWOOD CT",
            "city": "NORTH BELLMORE",
            "state": "NY",
            "postal_code": "117103154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1428 5TH AVE",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117064147",
            "telephone_number": "631-665-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPIEGEL",
        "first_name": "JACLYN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-05",
        "last_updated": "2015-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "NY",
            "license": "1875262",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NY",
            "license": "019721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03926969",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southside Hospital Department of Neurology
• Southside Hospital Department of Pathology
• Southside Hospital Department of Psychiatry
• Southside Hospital Emergency Department
• Southside Hospital Faculty Practice
• Rex Spielmann, MD
• Richard Frank Spinello
• Peter Alex Spiratos
• Joanne St.Robert
• Siobhan Catherine Stack, DPT

• Clinical Child & Adolescent Psychologist in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Clinical Child & Adolescent Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; 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.