Active NPI
Wade Brian Anderson, PH.D.
- Clinical Psychologist
- Pleasantville, NY
National Provider Identifier
1225658339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 013637-1
- Practice address
- 90 Grandview Ave
Pleasantville, NY 10570-2035 - Phone
- (914) 564-8167
- NPI assigned
- Apr 18, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Psychologist | 103TF0000X | 013637-1 | NY | |
| Psychoanalysis Psychologist | 103TP0814X | 013637-1 | NY | |
| Clinical Psychologist | 103TC0700X | 013637-1 | NY | Primary |
Addresses
Primary practice location
90 Grandview Ave
Pleasantville, NY 10570-2035
Mailing address
90 Grandview Ave
Pleasantville, NY 10570-2035
Phone (914) 564-8167
Other practice location 1
547 Saw Mill River Rd
Ardsley, NY 10502-2143
Phone (914) 564-8167
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 |
|---|---|---|---|
| 013637-1 | NY | MD | Family Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587168000000",
"number": "1225658339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 GRANDVIEW AVE",
"city": "PLEASANTVILLE",
"state": "NY",
"postal_code": "105702035",
"telephone_number": "914-564-8167"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 GRANDVIEW AVE",
"city": "PLEASANTVILLE",
"state": "NY",
"postal_code": "105702035",
"telephone_number": "914-564-8167"
}
],
"practiceLocations": [
{
"address_1": "547 Saw Mill River Rd",
"address_purpose": "LOCATION",
"city": "Ardsley",
"state": "NY",
"postal_code": "105022143",
"country_code": "US",
"telephone_number": "914-564-8167",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ANDERSON",
"first_name": "WADE",
"middle_name": "BRIAN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-18",
"last_updated": "2020-04-18",
"certification_date": "2020-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "NY",
"license": "013637-1",
"primary": false
},
{
"code": "103TP0814X",
"taxonomy_group": "",
"desc": "Psychologist, Psychoanalysis",
"state": "NY",
"license": "013637-1",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "013637-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasantville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.