Active NPI
Elizabeth Ann Jago, PSY.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1538404090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 021075
- Practice address
- 12 W 9TH St
Suite 1B-2
New York, NY 10011-8905 - Phone
- (347) 927-1657
- NPI assigned
- Dec 10, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071008475 | IL | |
| Clinical Psychologist | 103TC0700X | 021075 | NY | Primary |
Addresses
Primary practice location
12 W 9TH St
Suite 1B-2
New York, NY 10011-8905
Mailing address
12 W 9TH St
Suite 1B-2
New York, NY 10011-8905
Phone (347) 927-1657
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 |
|---|---|---|---|
| 071008475 | IL | MD | Clinical Psychologist |
| 021075 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462320000000",
"number": "1538404090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 W 9TH ST",
"address_2": "SUITE 1B-2",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100118905",
"telephone_number": "347-927-1657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 W 9TH ST",
"address_2": "SUITE 1B-2",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100118905",
"telephone_number": "347-927-1657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAGO",
"first_name": "ELIZABETH",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-12-10",
"last_updated": "2016-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071008475",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "021075",
"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 May 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.