Active NPI
Tirrell De Gannes, PSY.D.
- Psychologist
- Hicksville, NY
National Provider Identifier
1336794742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1629175039
- Practice address
- 400 S Oyster Bay Rd Ste 102
Hicksville, NY 11801-3500 - Phone
- (516) 818-8383
- NPI assigned
- Aug 3, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1629175039 | NY | Primary |
Addresses
Primary practice location
400 S Oyster Bay Rd Ste 102
Hicksville, NY 11801-3500
Mailing address
10750 164TH St
Jamaica, NY 11433-2435
Phone (718) 564-3879
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 |
|---|---|---|---|
| 1629175039 | NY | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564790400000",
"number": "1336794742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10750 164TH ST",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114332435",
"telephone_number": "718-564-3879"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 S OYSTER BAY RD STE 102",
"city": "HICKSVILLE",
"state": "NY",
"postal_code": "118013500",
"telephone_number": "516-818-8383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE GANNES",
"first_name": "TIRRELL",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-03",
"last_updated": "2019-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "1629175039",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hicksville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.