Nikki A Gustavson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

019182 Issued in NY

Practice address

275 Broadhollow Rd Ste 120
Melville, NY 11747-4863

Phone

(845) 279-5908

Fax

(845) 622-5055

NPI assigned

Oct 23, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Psychologist

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carmel Psychological Health PCGroup PAC ID 4385530351, 222 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21444/brand/1/csg/1/fhir/r4

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.

• Carmel Psychological Health, PC

  • Psychologist
  • Carmel, NY
  • NPI 1720194335
  Care Compare group NPD
• Just Kids Early Childhood Learning Center

  • Licensed Practical Nurse
  • Middle Island, NY
  • NPI 1528786076
  NPD
• Just Kids Diagnostic and Treatment Center Inc

  • Clinic/Center
  • Middle Island, NY
  • NPI 1265570493
  NPD (past)

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

{
    "created_epoch": "1603411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780358400000",
    "number": "1174122816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 BROADHOLLOW RD STE 120",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117474863",
            "telephone_number": "845-279-5908",
            "fax_number": "845-622-5055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 BROADHOLLOW RD STE 120",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117474863",
            "telephone_number": "845-279-5908",
            "fax_number": "845-622-5055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAVSON",
        "first_name": "NIKKI",
        "middle_name": "A",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-23",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "019182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leila Guillaume
• Evelyn Guillermo
• Frank T Guillot, RPH
• Kristina Tulasi Gulab
• Roshni Gurung
• Keilyn Gutierrez
• Stephanie Gutierrez
• Stefanina Guttilla
• Jill Guttman, MS ED
• Gymguyz LLC

• Clinical Psychologist in Melville, NY
• Providers in Melville, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.