Active NPI
Miel Norwood Fajen, ED.D.
- Psychologist
- Latham, NY
National Provider Identifier
1174925325
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 020859
- Practice address
- 475 Watervliet Shaker Rd
Latham, NY 12110-4622 - Phone
- (518) 785-1341
- NPI assigned
- Sep 18, 2014
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 020859 | NY | Primary |
Addresses
Primary practice location
475 Watervliet Shaker Rd
Latham, NY 12110-4622
Mailing address
317 County Route 7
Nassau, NY 12123-3132
Phone (518) 785-1341
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410998400000",
"number": "1174925325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "317 COUNTY ROUTE 7",
"city": "NASSAU",
"state": "NY",
"postal_code": "121233132",
"telephone_number": "518-785-1341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "475 WATERVLIET SHAKER RD",
"city": "LATHAM",
"state": "NY",
"postal_code": "121104622",
"telephone_number": "518-785-1341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAJEN",
"first_name": "MIEL",
"middle_name": "NORWOOD",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-18",
"last_updated": "2014-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "020859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Latham, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.