Individual provider Active NPI

Graham George Kavanagh, PH.D.

  • Psychologist
  • New York, NY
National Provider Identifier
1194772434
Registry record updated Feb 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
008331 Issued in NY
Practice address
211 W 56TH St
35A
New York, NY 10019-4312
Phone
(212) 247-1831
Fax
(212) 247-0255
NPI assigned
May 30, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 008331 NY Primary

Addresses

Primary practice location

211 W 56TH St
35A
New York, NY 10019-4312

Mailing address

211 W 56TH St
35A
New York, NY 10019-4312
Phone (212) 247-1831

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070829000412 NY Practitioner - Clinical Psychologist 9931292430 Practice locations: New York, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

211 W 56TH St
Apt 14D
New York, NY 10019-4319
Phone (212) 247-1831

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
008331NYMDOccupational Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392595200000",
    "number": "1194772434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 W 56TH ST",
            "address_2": "35A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100194312",
            "telephone_number": "212-247-1831",
            "fax_number": "212-247-0255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 W 56TH ST",
            "address_2": "35A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100194312",
            "telephone_number": "212-247-1831",
            "fax_number": "212-247-0255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAVANAGH",
        "first_name": "GRAHAM",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2014-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "008331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.