Active NPI
Jeannette Kristine Correa
- Psychologist
- Latham, NY
National Provider Identifier
1427798529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 024863
- Practice address
- 15 Cornell Rd Ste 2
Latham, NY 12110-1490 - Phone
- (518) 510-3100
- NPI assigned
- Mar 29, 2022
- Last updated
- Jan 27, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 024863 | NY | Primary |
Addresses
Primary practice location
15 Cornell Rd Ste 2
Latham, NY 12110-1490
Mailing address
15 Cornell Rd Ste 2
Latham, NY 12110-1490
Phone (518) 510-3100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 8, 2022 through Dec 8, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024863 | NY | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674777600000",
"number": "1427798529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 CORNELL RD STE 2",
"city": "LATHAM",
"state": "NY",
"postal_code": "121101490",
"telephone_number": "518-510-3100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 CORNELL RD STE 2",
"city": "LATHAM",
"state": "NY",
"postal_code": "121101490",
"telephone_number": "518-510-3100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORREA",
"first_name": "JEANNETTE",
"middle_name": "KRISTINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-29",
"last_updated": "2023-01-27",
"certification_date": "2023-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "024863",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Latham, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.