Dmitriy Kazakov, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2997224 Issued in NY

Practice address

10 Pearl St FL 2
Port Chester, NY 10573-4611

Phone

(914) 265-2762

NPI assigned

Nov 2, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

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

Specialty

Clinical Psychologist

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carmel Psychological Health PCGroup PAC ID 4385530351, 222 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Carmel Psychological Health, PC

  dba LifeStance Psychology

  • Psychologist
  • Carmel, NY
  • NPI 1720194335
  Medicare reassignment Care Compare group NPD
• Advanced Telepsych PLLC

  • Psychiatry Physician
  • Middletown, CT
  • NPI 1508456377
  NPD

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

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784246400000",
    "number": "1336804541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 PEARL ST FL 2",
            "city": "PORT CHESTER",
            "state": "NY",
            "postal_code": "105734611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 PEARL ST FL 2",
            "city": "PORT CHESTER",
            "state": "NY",
            "postal_code": "105734611",
            "telephone_number": "914-265-2762"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "609 W Johnson Ave Ste 104",
            "address_purpose": "LOCATION",
            "city": "Cheshire",
            "state": "CT",
            "postal_code": "064104506",
            "country_code": "US",
            "telephone_number": "203-272-6007",
            "fax_number": "203-272-8895",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAZAKOV",
        "first_name": "DMITRIY",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-02",
        "last_updated": "2026-07-17",
        "certification_date": "2026-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "4127",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NY",
            "license": "2997224",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "2997224",
            "primary": true
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CT",
            "license": "4127",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Enrique Carlos Jinete, DPT
• Aspen Jordan-Platow
• Saad Kaif, DO
• Chanda Kale, DDS
• Jessica Kastin, PSYD
• Crysta Jane Kearney, MS.ED
• Abby Kemp, CPNP
• Mohammed Naeem Khan, PHARM.D.
• Joseph R Kiefer, MPT
• Toni Marie King, M.S., L. AC.

• Clinical Psychologist in Port Chester, NY
• Providers in Port Chester, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.