Active NPI
Diane Carol Hahn
- Clinical Child & Adolescent Psychologist
- Canandaigua, NY
National Provider Identifier
1164716551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- Practice address
- 3180 West St
Canandaigua, NY 14424-1722 - Phone
- (585) 394-1442
- NPI assigned
- Jun 3, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | Primary |
Addresses
Primary practice location
3180 West St
Canandaigua, NY 14424-1722
Mailing address
3180 West St
Canandaigua, NY 14424-1722
Phone (585) 394-1442
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180130000548 | NY | Order and Referring Only - Clinical Psychologist | 4183984768 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020419 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391385600000",
"number": "1164716551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3180 WEST ST",
"city": "CANANDAIGUA",
"state": "NY",
"postal_code": "144241722",
"telephone_number": "585-394-1442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3180 WEST ST",
"city": "CANANDAIGUA",
"state": "NY",
"postal_code": "144241722",
"telephone_number": "585-394-1442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAHN",
"first_name": "DIANE",
"middle_name": "CAROL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-03",
"last_updated": "2014-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canandaigua, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.