Active NPI
Joan Ellen Lavender, PSY. D.
- Psychologist
- New York, NY
National Provider Identifier
1265545800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 010767
- Practice address
- 680 W End Ave
1B
New York, NY 10025-6815 - Phone
- (212) 866-0461
- Fax
- (917) 493-0132
- NPI assigned
- Aug 17, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 010767 | NY | Primary |
| Psychologist | 103T00000X | 03910 | NJ |
Addresses
Primary practice location
680 W End Ave
1B
New York, NY 10025-6815
Mailing address
327 Central Park West 11E
1B
New York, NY 10025
Phone (212) 866-0461
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 27, 2020 through Feb 27, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03910 | NJ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265545800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "327 CENTRAL PARK WEST 11E",
"address_2": "1B",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10025",
"telephone_number": "212-866-0461",
"fax_number": "917-493-0132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 W END AVE",
"address_2": "1B",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100256815",
"telephone_number": "212-866-0461",
"fax_number": "917-493-0132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAVENDER",
"first_name": "JOAN",
"middle_name": "ELLEN",
"name_prefix": "Dr.",
"credential": "PSY. D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "010767",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NJ",
"license": "03910",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
- Lavender California Psychiatric Nursing PC
- Lavender Health NP in Family Health PLLC
- Lavender Kansas Psychiatric Nurse Practitioner PA
- Lavender New Jersey Psychiatric Nurse Practitioner PC
- Lavender New York Nurse Practitioner in Psychiatry PC
- Steven James Lavender, PT
- Lorraine Lavenita, L. AC.
- Amanda Laventure, PSYD
- Zayani Lavergne-Friedman, LMSW
- Simone Laverne, LP
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.