Active NPI
Cheryl Pruett II, PH.D.
- Clinical Psychologist
- Bath, NY
National Provider Identifier
1205916327
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 11297
- Practice address
- 115 Liberty St
Bath, NY 14810-1508 - Phone
- (607) 776-6577
- NPI assigned
- Oct 16, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 11297 | NY | Primary |
Addresses
Primary practice location
115 Liberty St
Bath, NY 14810-1508
Mailing address
90 Belle Cornell Dr
Montour Falls, NY 14865-9609
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38653L | Medicaid | NY |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11297 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205916327",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 BELLE CORNELL DR",
"city": "MONTOUR FALLS",
"state": "NY",
"postal_code": "148659609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 LIBERTY ST",
"city": "BATH",
"state": "NY",
"postal_code": "148101508",
"telephone_number": "607-776-6577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUETT",
"first_name": "CHERYL",
"name_suffix": "II",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "11297",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38653L",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bath, NY
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.