Psychological Services for Self and Family, PLLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

009823-1 Issued in NY

Legal business name

PSYCHOLOGICAL SERVICES FOR SELF AND FAMILY, PLLC

Practice address

523 E Genesee St
Fayetteville, NY 13066-1536

Phone

(315) 637-9131

Fax

(315) 637-9151

NPI assigned

Jul 19, 2010

Organization subpart

No

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

Authorized official

Name

Paul M. Cohen, PH.D.NPI 1134143951

Title

Owner

Phone

(315) 637-9131

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paul Michael Cohen, PH.D.

  • Psychologist
  • Fayetteville, NY
  • NPI 1134143951
  Medicare reassignment NPD Authorized official
• Marni Marie Millet, LCSW

  • Clinical Social Worker
  • Syracuse, NY
  • NPI 1124367669
  NPD (past)

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

{
    "created_epoch": "1279497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279497600000",
    "number": "1417260571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 E GENESEE ST",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130661536",
            "telephone_number": "315-637-9131",
            "fax_number": "315-637-9151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 E GENESEE ST",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130661536",
            "telephone_number": "315-637-9131",
            "fax_number": "315-637-9151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL SERVICES FOR SELF AND FAMILY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-19",
        "last_updated": "2010-07-19",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-637-9131",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "NY",
            "license": "009823-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellen E Powers, NP
• James Prezzano, M.D.
• Kelly Price, LMHC
• Steven A Procopio Jr., DDS
• Mark A Profetto, FNP
• Ran D Anbar, Inc
• Susan M Randall-Mantella, RNNP
• Deanna Raymond Allen, P.A
• Cary Rector, M.S., LMHC
• Tonja S. Rector, LMFT

• Psychologist in Fayetteville, NY
• Providers in Fayetteville, 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 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.