Despina Petsagourakis, MA

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

025838 Issued in NY

Practice address

1 Park Ave FL 7
New York, NY 10016-5818

Phone

(646) 754-5000

NPI assigned

May 31, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

Practice roles

Locations

Networks

• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359

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.

• New York University

  • Cardiovascular Disease Physician
  • Boynton Beach, FL
  • NPI 1285826438

  NY

  Medicare reassignment NPD
• New York University

  • Physical Medicine & Rehabilitation Physician
  • Boynton Beach, FL
  • NPI 1104787613
  NPD

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

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1447742044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PARK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100165802",
            "telephone_number": "646-754-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PARK AVE FL 7",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100165818",
            "telephone_number": "646-754-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "73 High St",
            "address_2": "MGH Charlestown HealthCare Center",
            "address_purpose": "LOCATION",
            "city": "Charlestown",
            "state": "MA",
            "postal_code": "021293026",
            "country_code": "US",
            "telephone_number": "617-726-3648",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETSAGOURAKIS",
        "first_name": "DESPINA",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-31",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MA",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NY",
            "license": "025838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Petrucz, PTA
• Lanae Petrus
• Alexander Petrush
• Elizabeth Petry, FNP
• Olga Petryna, MD
• Vaitsa Petsiavas
• Dorothy Petsoulakis, RN
• Ayanna Pettaway, LMHC
• Jocelyn Rose Pettenato, LCSW
• Claire Pettengill, RN

• Clinical Child & Adolescent Psychologist in New York, NY
• Providers in New York, NY by specialty
• Clinical Child & Adolescent Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.