Active NPI
Allysen Manz, PH.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1346213030
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 016492
- Practice address
- 130 5TH Ave
New York, NY 10011-4306 - Phone
- (917) 293-7734
- Fax
- (212) 806-0706
- NPI assigned
- Feb 11, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 016492 | NY | Primary |
Addresses
Primary practice location
130 5TH Ave
New York, NY 10011-4306
Mailing address
570 Westminster Rd
Brooklyn, NY 11230-1448
Phone (917) 293-7734
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 5, 2024 through May 5, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016492 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184198400000",
"number": "1346213030",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "570 WESTMINSTER RD",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112301448",
"telephone_number": "917-293-7734",
"fax_number": "212-806-0706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 5TH AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100114306",
"telephone_number": "917-293-7734",
"fax_number": "212-806-0706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANZ",
"first_name": "ALLYSEN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-11",
"last_updated": "2007-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "016492",
"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 Jul 12, 2007; 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.