Active NPI
Melissa Dackis, PH.D.
- Clinical Psychologist
- Bronx, NY
National Provider Identifier
1598210221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 021163
- Practice address
- 3340 Bainbridge Ave
Bronx, NY 10467-2802 - Phone
- (718) 696-3011
- NPI assigned
- Aug 23, 2016
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 021163 | NY | Primary |
Addresses
Primary practice location
3340 Bainbridge Ave
Bronx, NY 10467-2802
Mailing address
33 W 88TH St
Apt 5
New York, NY 10024-2537
Phone (908) 930-0412
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 2, 2020 through Dec 2, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471910400000",
"number": "1598210221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33 W 88TH ST",
"address_2": "APT 5",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100242537",
"telephone_number": "908-930-0412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3340 BAINBRIDGE AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104672802",
"telephone_number": "718-696-3011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DACKIS",
"first_name": "MELISSA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-23",
"last_updated": "2016-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "021163",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.