Active NPI
Carl James Kittleson, PSY.D.
- Clinical Psychologist
- Bath, NY
National Provider Identifier
1609831304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 015593-1
- Practice address
- 76 Veterans Ave
Bath, NY 14810-0810 - Phone
- (607) 664-4316
- Fax
- (607) 664-4320
- NPI assigned
- Apr 18, 2006
- Last updated
- Jul 8, 2007
- 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 | 015593-1 | NY | Primary |
Addresses
Primary practice location
76 Veterans Ave
Bath, NY 14810-0810
Mailing address
76 Veterans Ave
Bath, NY 14810-0810
Phone (607) 664-4316
Other names 1
- Jim Kittleson
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015593-1 | NY | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609831304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "76 VETERANS AVE",
"city": "BATH",
"state": "NY",
"postal_code": "148100810",
"telephone_number": "607-664-4316",
"fax_number": "607-664-4320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "76 VETERANS AVE",
"city": "BATH",
"state": "NY",
"postal_code": "148100810",
"telephone_number": "607-664-4316",
"fax_number": "607-664-4320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KITTLESON",
"first_name": "CARL",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "015593-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JIM",
"last_name": "KITTLESON",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Bath, NY
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.