Steven Boksenbaum, PH.D. – Clinical Neuropsychologist

Key facts

NPI: 1558074773
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Neuropsychologist 103G00000X
License: 002186 (CT)
Practice address: 100 Melrose Ave Ste 203
Greenwich, CT 06830-6277
Phone: (203) 613-7311
NPI assigned: Jan 3, 2023
Sex: Male
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Doctor of Philosophy

State licenses

License	State	Type	Specialty
002186	CT	MD	Physician Assistant

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Psychologist	103T00000X	002186	CT
Clinical Neuropsychologist	103G00000X	002186	CT	Yes

Addresses

Primary practice location

100 Melrose Ave Ste 203
Greenwich, CT 06830-6277

Mailing address

100 Melrose Ave Ste 203
Greenwich, CT 06830-6277
Phone (203) 613-7311

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 3, 2023.

{
    "created_epoch": "1672704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1558074773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MELROSE AVE STE 203",
            "city": "GREENWICH",
            "state": "CT",
            "postal_code": "068306277",
            "telephone_number": "203-613-7311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MELROSE AVE STE 203",
            "city": "GREENWICH",
            "state": "CT",
            "postal_code": "068306277",
            "telephone_number": "203-613-7311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOKSENBAUM",
        "first_name": "STEVEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-03",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CT",
            "license": "002186",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CT",
            "license": "002186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwich, CT

All providers in Greenwich, CT · Clinical Neuropsychologist in Connecticut

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.