Active NPI
Ellen B. Simpao, PH.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1407939820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 14505 - 01
- Practice address
- 14 E 4TH St
Suite 401
New York, NY 10012-1155 - Phone
- (212) 254-6028
- Fax
- (718) 788-4077
- NPI assigned
- Oct 21, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | 14505 - 01 | NY | Primary |
Addresses
Primary practice location
14 E 4TH St
Suite 401
New York, NY 10012-1155
Mailing address
307 11TH St
Brooklyn, NY 11215-3910
Phone (718) 788-4077
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14505 - 01 | NY | MD | Clinical Psychologist |
| 014505 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407939820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "307 11TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112153910",
"telephone_number": "718-788-4077",
"fax_number": "718-788-4077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14 E 4TH ST",
"address_2": "SUITE 401",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100121155",
"telephone_number": "212-254-6028",
"fax_number": "718-788-4077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMPAO",
"first_name": "ELLEN",
"middle_name": "B.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "14505 - 01",
"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 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.