Active NPI
Mia Rose Wiston
- Psychologist
- New York, NY
National Provider Identifier
1518550946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 024084
- Practice address
- 270 Lafayette St Ste 702
New York, NY 10012-3384 - Phone
- (914) 275-5138
- NPI assigned
- Feb 17, 2021
- Sex
- Female
- Sole proprietor
- No
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 | 024084 | NY | Primary |
Addresses
Primary practice location
270 Lafayette St Ste 702
New York, NY 10012-3384
Mailing address
150 Rivington St Apt PHC
New York, NY 10002-5486
Phone (914) 275-5138
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024084 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613520000000",
"number": "1518550946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 RIVINGTON ST APT PHC",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100025486",
"telephone_number": "914-275-5138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "270 LAFAYETTE ST STE 702",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100123384",
"telephone_number": "914-275-5138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISTON",
"first_name": "MIA",
"middle_name": "ROSE",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-17",
"last_updated": "2021-02-17",
"certification_date": "2021-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "024084",
"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 Feb 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.