Active NPI
Phyllis Ann Perna, PSY.D.
- Clinical Psychologist
- Elizabethtown, NY
National Provider Identifier
1518018019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 018491-1
- Practice address
- 107 Hand Avenue
Elizabethtown, NY 12932 - Phone
- (518) 962-8884
- NPI assigned
- Jan 13, 2007
- Last updated
- Mar 28, 2020
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 018491-1 | NY | Primary |
Addresses
Primary practice location
107 Hand Avenue
Elizabethtown, NY 12932
Mailing address
527 Stevenson Rd
Westport, NY 12993-2219
Phone (610) 730-5613
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001535699 | Medicaid | PA |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 018491-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585353600000",
"number": "1518018019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "527 STEVENSON RD",
"city": "WESTPORT",
"state": "NY",
"postal_code": "129932219",
"telephone_number": "610-730-5613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 HAND AVENUE",
"city": "ELIZABETHTOWN",
"state": "NY",
"postal_code": "12932",
"telephone_number": "518-962-8884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERNA",
"first_name": "PHYLLIS",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-13",
"last_updated": "2020-03-28",
"certification_date": "2020-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "018491-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001535699",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elizabethtown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.