Active NPI
Goldie M Jurarel, MSE.
- Clinical Child & Adolescent Psychologist
- Fallsbury, NY
National Provider Identifier
1346688082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 217528150
- Practice address
- 61 Laurel Park Road
Apt H5
Fallsbury, NY 12733 - Phone
- (845) 423-8970
- Fax
- (845) 434-5696
- NPI assigned
- Jun 4, 2013
- Last updated
- Jun 4, 2013
- 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 Child & Adolescent Psychologist | 103TC2200X | 217528150 | NY | Primary |
Addresses
Primary practice location
61 Laurel Park Road
Apt H5
Fallsbury, NY 12733
Mailing address
61 Laurel Park Road
Apt H5
Fallsbury, NY 12733
Phone (845) 423-8970
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ET881535 | Medicaid | NY |
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 |
|---|---|---|---|
| 217528150 | NY | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370304000000",
"number": "1346688082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "61 LAUREL PARK ROAD",
"address_2": "APT H5",
"city": "FALLSBURY",
"state": "NY",
"postal_code": "12733",
"telephone_number": "845-423-8970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "61 LAUREL PARK ROAD",
"address_2": "APT H5",
"city": "FALLSBURY",
"state": "NY",
"postal_code": "12733",
"telephone_number": "845-423-8970",
"fax_number": "845-434-5696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JURAREL",
"first_name": "GOLDIE",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "MSE.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-04",
"last_updated": "2013-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NY",
"license": "217528150",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ET881535",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.