Supportive Psychological Services of Long Island, P.C.

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

SUPPORTIVE PSYCHOLOGICAL SERVICES OF LONG ISLAND, P.C.

Practice address

6500 Jericho Tpke
Commack, NY 11725-2909

Phone

(631) 252-1221

NPI assigned

Apr 28, 2017

Last updated

Apr 28, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Linda Ganzenmuller, PSY.D.NPI 1720144900

Title

President

Phone

(631) 252-1221

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Linda Ganzenmuller, PSYD

  • Psychologist
  • Commack, NY
  • NPI 1720144900
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1493337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1285169193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1226",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117250900",
            "telephone_number": "631-252-1221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 JERICHO TPKE",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252909",
            "telephone_number": "631-252-1221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE PSYCHOLOGICAL SERVICES OF LONG ISLAND, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-28",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "GANZENMULLER",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-252-1221",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Commack, NY
• Providers in Commack, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.