Individual provider Active NPI

Kerri L Moreland, PSYD

  • Psychologist
  • West Islip, NY
National Provider Identifier
1558688358
Registry record updated Oct 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
018184 Issued in NY
Practice address
400 Montauk Hwy
112
West Islip, NY 11795-4429
Phone
(631) 321-7107
Fax
(631) 321-7108
NPI assigned
May 3, 2010
Last updated
Oct 22, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 018184 NY Primary

Addresses

Primary practice location

400 Montauk Hwy
112
West Islip, NY 11795-4429

Mailing address

15 Oak Neck Rd
West Islip, NY 11795-4322
Phone (516) 768-2400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151112001879 NY Practitioner - Clinical Psychologist 9830409390 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bandl Cognitive Behavioral Psychology PLLCGroup PAC ID 1153470828, 7 clinicians

Practice addresses (Care Compare)

165 N Village Ave
Rockville Centre, NY 11570-3701
Phone (516) 665-9669

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
B&L Cognitive Behavioral Psychology PLLC CurrentSince Oct 15, 2015 Accepting new patients

Locations

165 N Village Ave
Ste 216
Rockville Ctr, NY 11570
Phone (516) 665-9669

400 Montauk Hwy
Ste 112
West Islip, NY 11795
Phone (631) 321-7107

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445472000000",
    "number": "1558688358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 OAK NECK RD",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954322",
            "telephone_number": "516-768-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MONTAUK HWY",
            "address_2": "112",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954429",
            "telephone_number": "631-321-7107",
            "fax_number": "631-321-7108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORELAND",
        "first_name": "KERRI",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-05-03",
        "last_updated": "2015-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "018184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Islip, NY

Sources for this page

Verify at the official NPI Registry.