Active NPI
Daniel Gibson, PSYD
- Psychologist
- Rego Park, NY
National Provider Identifier
1265595516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- P54612
- Practice address
- 98120 Queens Blvd
Apt 1C
Rego Park, NY 11374 - Phone
- (718) 830-0246
- Fax
- (718) 830-9088
- NPI assigned
- Dec 18, 2006
- Sex
- Male
- Sole proprietor
- No
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 | P54612 | NY | Primary |
| Clinical Psychologist | 103TC0700X | 018394 | NY |
Addresses
Primary practice location
98120 Queens Blvd
Apt 1C
Rego Park, NY 11374
Mailing address
98120 Queens Blvd
Apt 1C
Rego Park, NY 11374
Phone (718) 830-0246
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P54612 | NY | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Comprehensive Counseling LCSW, PLLC | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1293926400000",
"number": "1265595516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "98120 QUEENS BLVD",
"address_2": "APT 1C",
"city": "REGO PARK",
"state": "NY",
"postal_code": "11374",
"telephone_number": "718-830-0246",
"fax_number": "718-830-9088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "98120 QUEENS BLVD",
"address_2": "APT 1C",
"city": "REGO PARK",
"state": "NY",
"postal_code": "11374",
"telephone_number": "718-830-0246",
"fax_number": "718-830-9088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-18",
"last_updated": "2011-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "P54612",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "018394",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rego Park, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.