Individual provider Active NPI

Andrew Petsche, PHD

  • Psychologist
  • Latham, NY
National Provider Identifier
1437707759
Registry record updated Oct 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
023323-01 Issued in NY
Practice address
20 Century Hill Dr Ste 202
Latham, NY 12110-2198
Phone
(518) 785-7283
Fax
(518) 785-7293
NPI assigned
Aug 29, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 023323-01 NY Primary

Addresses

Primary practice location

20 Century Hill Dr Ste 202
Latham, NY 12110-2198

Mailing address

20 Century Hill Dr Ste 202
Latham, NY 12110-2198
Phone (518) 229-1692

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)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
023323-01NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Petsche Psychology Practice, PLLC Psychologist CurrentSince Nov 19, 2023 Accepting new patients
Capital District Behavioral Health Psychologists, PLLC CurrentSince Sep 1, 2019 Accepting new patients

Locations

20 Century Hill Dr
Ste 202
Latham, NY 12110
Phone (518) 577-8822

21 British American Blvd
Latham, NY 12110
Phone (518) 344-4141

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1567036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666742400000",
    "number": "1437707759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 CENTURY HILL DR STE 202",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102198",
            "telephone_number": "518-229-1692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 CENTURY HILL DR STE 202",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102198",
            "telephone_number": "518-785-7283",
            "fax_number": "518-785-7293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETSCHE",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-29",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "023323-01",
            "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 Oct 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.