Alexander Joseph Hinnebusch, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

025389-01 Issued in NY

Practice address

4758 Lynnville Way
Clay, NY 13041-8990

Phone

(240) 274-0012

NPI assigned

Feb 19, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Evergreen Mental Health & Assessment, LLC

  • Clinical Psychologist
  • Clay, NY
  • NPI 1073225090
  NPD Authorized official

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

{
    "created_epoch": "1518998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1184124901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4758 LYNNVILLE WAY",
            "city": "CLAY",
            "state": "NY",
            "postal_code": "130418990",
            "telephone_number": "240-274-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4758 LYNNVILLE WAY",
            "city": "CLAY",
            "state": "NY",
            "postal_code": "130418990",
            "telephone_number": "240-274-0012"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3333 Burnet Avenue",
            "address_2": "MLC 3015",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "45229",
            "country_code": "US",
            "telephone_number": "513-636-4336",
            "fax_number": "513-636-7756",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 E Eisenhower Pkwy Spc 5744",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481083364",
            "country_code": "US",
            "telephone_number": "734-936-7052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HINNEBUSCH",
        "first_name": "ALEXANDER",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-19",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "OH",
            "license": "P.07748",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "P.07748",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "6301016833",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "025389-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julianne Mary Francey, RN
• Sue P Gardner, LCSW
• Sara Elizabeth Gordon, PTA
• Cynthia Ann Greenfield, RN
• Terri Jo Henrich, LPN
• Caitlin Hoosock, FNP-C
• Steven Mitchell Jobson, LCSW
• Howard Jeffrey Kass, O.D.
• Stephanie Marie Kelly, LPN
• Rebecca Ann Knafelc, RD, CSG, CDN

• Clinical Psychologist in Clay, NY
• Providers in Clay, 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 Dec 21, 2022; 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.