Individual provider Active NPI

Irina Vakhnyanskaya, PHD

  • Clinical Psychologist
  • Brooklyn, NY
National Provider Identifier
1285663963
Registry record updated Feb 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
016487 Issued in NY
Practice address
5110 12TH Ave
Brooklyn, NY 11219-3424
Phone
(800) 275-3243
Fax
(800) 275-3671
NPI assigned
Jul 3, 2006
Last updated
Feb 16, 2012By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 016487 NY Primary

Addresses

Primary practice location

5110 12TH Ave
Brooklyn, NY 11219-3424

Mailing address

775 Westminster Rd
1013 East 13 Street Apt a-10
Brooklyn, NY 11230-2401
Phone (718) 258-7190

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060131000075 NY Practitioner - Clinical Psychologist 0941214829 Reassigns benefits to 3 organizations
Practice locations: Brooklyn, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Benzaquen Psychological Services PLLCGroup PAC ID 4688771298, 2 clinicians
Che Senior Psychological Services, PCGroup PAC ID 8022905314, 227 clinicians

Practice addresses (Care Compare)

143 Maple Ave
Cedarhurst, NY 11516-2225
Phone (516) 295-4104

250 Beach 17TH St
Far Rockaway, NY 11691-4420
Phone (800) 275-3243

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
016487NYMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Che Senior Psychological Services, PC Clinical CurrentSince Oct 15, 2013 Accepting new patients
Knapp Street Psychiatry, PC Clinical CurrentSince Oct 15, 2013 Accepting new patients

Locations

1915 Ocean Ave
Brooklyn, NY 11230
Phone (718) 258-7700

2840 Knapp St
Brooklyn, NY 11235
Phone (516) 405-6700

3512 Quentin Rd
Ste 110
Brooklyn, NY 11234
Phone (718) 854-8370

3900 Shore Pkwy
Brooklyn, NY 11235
Phone (718) 646-5700

5110 12th Ave
Brooklyn, NY 11219
Phone (718) 854-8370

615 Avenue C
Brooklyn, NY 11218
Phone (718) 633-3300

250 Beach 17th St
Far Rockaway, NY 11691
Phone (516) 670-0212

4120 Broadway
New York, NY 10033
Phone (212) 543-1800

209 Beach 125th St
Rockaway Park, NY 11694
Phone (516) 721-7625

135 Vanderbilt Ave
Staten Island, NY 10304
Phone (718) 447-0101

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329350400000",
    "number": "1285663963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "775 WESTMINSTER RD",
            "address_2": "1013 EAST 13 STREET APT A-10",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112302401",
            "telephone_number": "718-258-7190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5110 12TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112193424",
            "telephone_number": "800-275-3243",
            "fax_number": "800-275-3671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAKHNYANSKAYA",
        "first_name": "IRINA",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-03",
        "last_updated": "2012-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "016487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.