Active NPI
Carolyn Ann Licht, PH.D.
- Psychologist
- New York, NY
National Provider Identifier
1487894077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 017934
- Practice address
- 7 W 86TH St
Suite 1Aa
New York, NY 10024-3603 - Phone
- (646) 660-0884
- Fax
- (646) 304-6804
- NPI assigned
- Feb 23, 2009
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 017934 | NY | Primary |
Addresses
Primary practice location
7 W 86TH St
Suite 1Aa
New York, NY 10024-3603
Mailing address
590 W End Ave
Apt. 2a
New York, NY 10024-1722
Phone (646) 660-0884
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 12, 2026 through Mar 12, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017934 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366156800000",
"number": "1487894077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "590 W END AVE",
"address_2": "APT. 2A",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100241722",
"telephone_number": "646-660-0884",
"fax_number": "646-304-6804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 W 86TH ST",
"address_2": "SUITE 1AA",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100243603",
"telephone_number": "646-660-0884",
"fax_number": "646-304-6804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICHT",
"first_name": "CAROLYN",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-02-23",
"last_updated": "2013-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "017934",
"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 Apr 17, 2013; 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.