Damien Tilliman

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

022266 Issued in NY

Practice address

4332 22ND St Ste 203
Long Island City, NY 11101-5077

Phone

(585) 750-0091

NPI assigned

Oct 3, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Psychologist

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mind in Motion Psychological Services, PLLCGroup PAC ID 0941634695, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Mind in Motion Psychological Services, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Long Island City, NY
  • NPI 1093362816
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1570060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1588205272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4332 22ND ST STE 203",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111015077",
            "telephone_number": "585-750-0091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4332 22ND ST STE 203",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111015077",
            "telephone_number": "585-750-0091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLIMAN",
        "first_name": "DAMIEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-03",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "022266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jiaxin Tian
• Brigitte Tibana
• Devindra Persaud Tilakdhari, RN
• Nicole Emily Tilin, OD
• Andra Tillery
• Mollie Tishberg
• Reginald Lao Tiu, P.T.
• Taniesha A Todd, RN
• Monica Clare Tolentino-Mendiola, RN
• Jingle Antonella Tolentino

• Clinical Psychologist in Long Island City, NY
• Providers in Long Island City, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.