Theresa Irene Desantis, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Practice address

1111 Broadhollow Rd
Suite 204
Farmingdale, NY 11735-4820

Phone

(631) 414-7181

Fax

(631) 414-7178

NPI assigned

Dec 5, 2006

Sex

Female

Sole proprietor

Yes

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, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• First Light Psychological Services, P.L.L.C.

  • Clinical Psychologist
  • Farmingdale, NY
  • NPI 1922166628
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194883884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 SALLY LN",
            "city": "PLAINVIEW",
            "state": "NY",
            "postal_code": "118031434",
            "telephone_number": "516-637-0689",
            "fax_number": "631-414-7178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 BROADHOLLOW RD",
            "address_2": "SUITE 204",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117354820",
            "telephone_number": "631-414-7181",
            "fax_number": "631-414-7178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESANTIS",
        "first_name": "THERESA",
        "middle_name": "IRENE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sophie Defreitas
• Donnareen Alemae Delansig Salcedo, NP
• Linda Marie Deleo, NP
• Mary T Denning, LCSW
• Department of Education
• Megan Elizabeth Desimone, OTR/L
• Sherif Desouky
• Sindy Destin
• Destino Medical Diagnostics PC
• Erika Di Gioia, OTR/L

• Clinical Psychologist in Farmingdale, NY
• Providers in Farmingdale, 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 Jul 8, 2007; 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.