Active NPI
John Robert Raykovitz, PHD
- Clinical Psychologist
- State College, PA
National Provider Identifier
1598864407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS005183L
- Practice address
- 110 Regent CT
Suite 103
State College, PA 16801 - Phone
- (814) 237-0551
- Fax
- (814) 237-0564
- NPI assigned
- Sep 21, 2006
- Sex
- Male
- 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 | PS005183L | PA | Primary |
Addresses
Primary practice location
110 Regent CT
Suite 103
State College, PA 16801
Mailing address
110 Regent CT
Suite 103
State College, PA 16801
Phone (814) 237-0551
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS005183L | PA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scenery Park Psychology Group | Clinical | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Clinical Psychologist
- State College, PA
- NPI 1891702445
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598864407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 REGENT CT",
"address_2": "SUITE 103",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "16801",
"telephone_number": "814-237-0551",
"fax_number": "814-237-0564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 REGENT CT",
"address_2": "SUITE 103",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "16801",
"telephone_number": "814-237-0551",
"fax_number": "814-237-0564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAYKOVITZ",
"first_name": "JOHN",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS005183L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in State College, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.