Active NPI
Kori Bennett, PSY.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1326397860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 021516
- Practice address
- 825 West End Avenue
1D
New York, NY 10025 - Phone
- (909) 969-8291
- NPI assigned
- Aug 30, 2012
- Last updated
- Oct 19, 2016
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 021516 | NY | Primary |
Addresses
Primary practice location
825 West End Avenue
1D
New York, NY 10025
Mailing address
825 West End Avenue
1D
New York, NY 10025
Phone (909) 969-8291
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 |
|---|---|---|---|
| 021516 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476835200000",
"number": "1326397860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "825 WEST END AVENUE",
"address_2": "1D",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10025",
"telephone_number": "909-969-8291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 WEST END AVENUE",
"address_2": "1D",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10025",
"telephone_number": "909-969-8291"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "KORI",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-30",
"last_updated": "2016-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "021516",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.