Individual provider Active NPI

Stephen S Taylor, PH.D.

  • Psychologist
  • Wantagh, NY
National Provider Identifier
1407298078
Registry record updated Jul 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
7204098 Issued in NY
Practice address
1051 Wantagh Ave
Wantagh, NY 11793-2109
Phone
(516) 785-0323
Fax
(516) 785-6026
NPI assigned
Jul 24, 2013
Last updated
Jul 24, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 24, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 7204098 NY Primary

Addresses

Primary practice location

1051 Wantagh Ave
Wantagh, NY 11793-2109

Mailing address

1051 Wantagh Ave
South Shore Counseling
Wantagh, NY 11793-2109
Phone (516) 785-0323

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200608001349 NY Practitioner - Clinical Psychologist 0648691220 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

199 Central Ave
Bethpage, NY 11714-3907
Phone (631) 522-7997

25 Carmans Rd
Suite 2
Massapequa, NY 11758-4749
Phone (631) 522-7997

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
7204098NYMDPsychologist
011810NYMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Tru Outreach Inc Psychologist CurrentSince May 3, 2020 Accepting new patients
South Shore Counseling and Psychological Services P C Past Accepting new patients

Locations

25 Carmans Rd
Ste 2
Massapequa, NY 11758
Phone (631) 522-7997

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1374624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374624000000",
    "number": "1407298078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1051 WANTAGH AVE",
            "address_2": "SOUTH SHORE COUNSELING",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117932109",
            "telephone_number": "516-785-0323",
            "fax_number": "516-785-6026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 WANTAGH AVE",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117932109",
            "telephone_number": "516-785-0323",
            "fax_number": "516-785-6026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "STEPHEN",
        "middle_name": "S",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-24",
        "last_updated": "2013-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "7204098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wantagh, NY

Sources for this page

Verify at the official NPI Registry.