Active NPI
Kerry Haddock, PSY.D.
- Psychologist
- Northport, NY
National Provider Identifier
1316728868
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 025768-01
- Practice address
- 81 Scudder Ave
Northport, NY 11768-2966 - Phone
- (631) 464-0260
- NPI assigned
- Oct 11, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 025768-01 | NY | Primary |
Addresses
Primary practice location
81 Scudder Ave
Northport, NY 11768-2966
Mailing address
81 Scudder Ave
Northport, NY 11768-2966
Phone (631) 464-0260
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, 2024 through Feb 27, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 025768-01 | NY | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1696982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774828800000",
"number": "1316728868",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "81 SCUDDER AVE",
"city": "NORTHPORT",
"state": "NY",
"postal_code": "117682966",
"telephone_number": "631-464-0260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "81 SCUDDER AVE",
"city": "NORTHPORT",
"state": "NY",
"postal_code": "117682966",
"telephone_number": "631-464-0260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HADDOCK",
"first_name": "KERRY",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-10-11",
"last_updated": "2026-03-30",
"certification_date": "2026-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "025768-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2026; 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.