NPIMap

Organization Active NPI

Senior Connections Psychological SE

  • Clinical Psychologist
  • Johnson City, NY
National Provider Identifier
1265482491
Registry record updated Oct 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
SENIOR CONNECTIONS PSYCHOLOGICAL SE
Practice address
270 Riverside Dr.
#201
Johnson City, NY 13790
Phone
(845) 781-6061
Fax
(607) 729-0757
NPI assigned
May 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2012

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

Authorized official

Name
Dr. Stephen Allen Daniel, PHDNPI 1942242896
Title
Owner
Phone
(845) 781-6061

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

270 Riverside Dr.
#201
Johnson City, NY 13790

Mailing address

P.O. Box 130926
Spring, TX 77393-0926
Phone (281) 292-1897

Other identifiers 2

IdentifierTypeStateIssuer
02668179MedicaidNY
DD5776OtherNYRAILROAD MEDICARE

Other names 1

  • Senior Connections Psychological Services of New York PC Other name

National Provider Directory

National Provider Directory

Locations

425 Robinson St
Fl 4
Binghamton, NY 13904
Phone (607) 729-0757

270 Riverside Dr
Apt 201
Johnson City, NY 13790
Phone (845) 781-6061

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349913600000",
    "number": "1265482491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 130926",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773930926",
            "telephone_number": "281-292-1897",
            "fax_number": "281-292-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 RIVERSIDE DR.",
            "address_2": "#201",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "13790",
            "telephone_number": "845-781-6061",
            "fax_number": "607-729-0757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR CONNECTIONS PSYCHOLOGICAL SE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2012-10-11",
        "status": "A",
        "authorized_official_last_name": "DANIEL",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "845-781-6061",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02668179",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DD5776",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Senior Connections Psychological Services of New York PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Johnson City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2012; 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.