Active NPI
Cynthia Ann Medalie, LCSW
- Psychoanalyst
- New York, NY
National Provider Identifier
1467622878
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychoanalyst
- License
- 0286371
- Practice address
- 30 W 86TH St
Suite 1F
New York, NY 10024-3644 - Phone
- (212) 787-5684
- NPI assigned
- Mar 3, 2008
- Last updated
- Mar 3, 2008
- 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 |
|---|---|---|---|---|
| Psychoanalyst | 102L00000X | 0286371 | NY | Primary |
Addresses
Primary practice location
30 W 86TH St
Suite 1F
New York, NY 10024-3644
Mailing address
30 W 86TH St
Suite 1F
New York, NY 10024-3644
Phone (212) 787-5684
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 19, 2023 through Jul 19, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0286371 | NY | MD | Psychoanalyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204502400000",
"number": "1467622878",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 W 86TH ST",
"address_2": "SUITE 1F",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100243644",
"telephone_number": "212-787-5684"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 W 86TH ST",
"address_2": "SUITE 1F",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100243644",
"telephone_number": "212-787-5684"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDALIE",
"first_name": "CYNTHIA",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-03",
"last_updated": "2008-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "102L00000X",
"taxonomy_group": "",
"desc": "Psychoanalyst",
"state": "NY",
"license": "0286371",
"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 Mar 3, 2008; 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.