Individual provider Active NPI

Paula Irene Janicki, PH.D/

  • Psychologist
  • Williamsville, NY
National Provider Identifier
1477562429
Registry record updated May 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
013229-1 Issued in NY
Practice address
5500 Main Street
Suite 308
Williamsville, NY 14221-6737
Phone
(716) 634-1184
Fax
(716) 634-1184
NPI assigned
Aug 7, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 22, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 013229-1 NY Primary

Addresses

Primary practice location

5500 Main Street
Suite 308
Williamsville, NY 14221-6737

Mailing address

5500 Main Street
Suite 308
Williamsville, NY 14221-6737
Phone (716) 634-1184

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20190227000230 NY Practitioner - Clinical Psychologist 2961741517 Practice locations: Williamsville, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1996
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

5500 Main St
Suite 308
Williamsville, NY 14221-6737
Phone (716) 634-1184

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
13229NYMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Watson Psychological Services, PLLC PastSince Feb 12, 2017 Accepting new patients

Organizations & group practices 1

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": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400716800000",
    "number": "1477562429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MAIN STREET",
            "address_2": "SUITE 308",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142216737",
            "telephone_number": "716-634-1184",
            "fax_number": "716-634-3207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 MAIN STREET",
            "address_2": "SUITE 308",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142216737",
            "telephone_number": "716-634-1184",
            "fax_number": "716-634-1184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANICKI",
        "first_name": "PAULA",
        "middle_name": "IRENE",
        "name_prefix": "Dr.",
        "credential": "PH.D/",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-07",
        "last_updated": "2014-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "013229-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.