Ketevan Gagnidze-McCormick, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

003123 Issued in NY

Practice address

10 Bruce St
Newburgh, NY 12550-6602

Phone

(845) 561-7284

NPI assigned

Jun 4, 2010

Last updated

Jun 4, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

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

Mental Health Counselor

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Wendy Keller, LCSW, LLCGroup PAC ID 7810169646, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Wendy Keller, LCSW, LLC

  dba Behavioral Health Services of the Hudson Valley

  • Clinical Social Worker
  • Newburgh, NY
  • NPI 1982992889
  Medicare reassignment Care Compare group NPD
• Psyprobill, LLC

  dba Behavioral Health Management Services

  • Community/Behavioral Health Agency
  • Newburgh, NY
  • NPI 1184076358
  Medicare reassignment NPD

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

{
    "created_epoch": "1275609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275609600000",
    "number": "1356661037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 BRUCE ST",
            "city": "NEWBURGH",
            "state": "NY",
            "postal_code": "125506602",
            "telephone_number": "845-561-7284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 BRUCE ST",
            "city": "NEWBURGH",
            "state": "NY",
            "postal_code": "125506602",
            "telephone_number": "845-561-7284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGNIDZE-MCCORMICK",
        "first_name": "KETEVAN",
        "name_prefix": "Mrs.",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-04",
        "last_updated": "2010-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "003123",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37PC00314800",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "44SW05190800",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Venus Fuller, LCSW
• Juan Gabriel, M.D.
• Gabriels Family Chiropractic, P.C. (Pine Street Family Chiropractic)
• Christopher Michael Gabriels, D.C.
• Dana Lee Gage, MD
• Danny Anthony Galasso, CASAC
• Angelyn Elizabeth Galati, LCSW
• Bryan Alexander Galecki, RPH
• Lisa Marie Gallo, CASAC
• Vincent Francis Gallo Jr., DPM

• Mental Health Counselor in Newburgh, NY
• Providers in Newburgh, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2010; 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.