Individual provider Active NPI

Anne Dalebroux Mykyta, PSY.D.

  • Psychologist
  • New York, NY
National Provider Identifier
1174897854
Registry record updated May 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
022230-1 Issued in NY
Practice address
341 East 79TH Street
Ste. 302
New York, NY 10075
Phone
(917) 740-5202
NPI assigned
Feb 28, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 28, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
School Psychologist 103TS0200X 530023111 NY
School Psychologist 103TS0200X 533364111 NY
Psychologist 103T00000X 022230-1 NY Primary

Addresses

Primary practice location

341 East 79TH Street
Ste. 302
New York, NY 10075

Mailing address

341 East 79TH Street
Ste. 302
New York, NY 10075
Phone (917) 740-5202

Other practice location 1

328 E 62nd St
New York, NY 10065-8206
Phone (212) 752-7575 ext. 355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
022230-1NYMDPsychologist
530023111NYMDSchool Psychologist
533364111NYMDSchool Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1330387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559001600000",
    "number": "1174897854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "341 EAST 79TH STREET",
            "address_2": "STE. 302",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10075",
            "telephone_number": "917-740-5202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "341 EAST 79TH STREET",
            "address_2": "STE. 302",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10075",
            "telephone_number": "917-740-5202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "328 E 62nd St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100658206",
            "country_code": "US",
            "telephone_number": "212-752-7575 x355",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MYKYTA",
        "first_name": "ANNE",
        "middle_name": "DALEBROUX",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-02-28",
        "last_updated": "2019-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "NY",
            "license": "530023111",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "NY",
            "license": "533364111",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "022230-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2019; 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.