Active NPI
Vanessa Fonseca Gomes, PHD
- Clinical Psychologist
- Smithtown, NY
National Provider Identifier
1609191840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 018134
- Practice address
- 811 W Jericho Tpke
106E
Smithtown, NY 11787-3232 - Phone
- (631) 265-9850
- NPI assigned
- Mar 31, 2010
- 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 | 018134 | NY | Primary |
Addresses
Primary practice location
811 W Jericho Tpke
106E
Smithtown, NY 11787-3232
Mailing address
811 W Jericho Tpke
106E
Smithtown, NY 11787-3232
Phone (631) 265-9850
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 1, 2024 through Feb 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 018134 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269993600000",
"number": "1609191840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "811 W JERICHO TPKE",
"address_2": "106E",
"city": "SMITHTOWN",
"state": "NY",
"postal_code": "117873232",
"telephone_number": "631-265-9850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "811 W JERICHO TPKE",
"address_2": "106E",
"city": "SMITHTOWN",
"state": "NY",
"postal_code": "117873232",
"telephone_number": "631-265-9850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMES",
"first_name": "VANESSA",
"middle_name": "FONSECA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-31",
"last_updated": "2010-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "018134",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Smithtown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2010; 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.