Susan W. Blue, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

010357-1 Issued in NY

Practice address

804 Valley PLZ
Johnson City, NY 13790-1009

Phone

(607) 797-1100

Fax

(607) 797-9514

NPI assigned

Oct 16, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oakdale Psychology Associates

  • Clinical Psychologist
  • Johnson City, NY
  • NPI 1497944318
  NPD (past) Authorized official
• Davenport Holistic Healing and Wellness LLC

  • Clinical Social Worker
  • Spencer, NY
  • NPI 1699590307
  NPD (past)
• Jerry Duvinsky PHD Licensed Psychologist PC

  • Clinical Psychologist
  • Endicott, NY
  • NPI 1043684681
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366522195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 WILDWOOD LN",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138503865",
            "telephone_number": "607-727-3903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 VALLEY PLZ",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137901009",
            "telephone_number": "607-797-1100",
            "fax_number": "607-797-9514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUE",
        "first_name": "SUSAN",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "010357-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BJ's Wholesale Club Inc.
• Angelina Blasich, LMSW
• Cassondra Blewett
• Ruth Anne Blizard, PH.D.
• Emily Grace Block, PA-C
• Michael Bobal, CNIM
• Bodyworks Physical Therapy LLC
• Cameron Alexander Bogicevic, PHARMD
• Shae Lynn Bolander, MD
• Radhika Bompalli, M.D

• Psychologist in Johnson City, NY
• Providers in Johnson City, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.