Active NPI
Robert Alfred Farrell, PH.D.
- Clinical Psychologist
- Great Neck, NY
National Provider Identifier
1609917608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 010188
- Practice address
- 10 Grace Ave
Suite 6
Great Neck, NY 11021-2423 - Phone
- (516) 829-5982
- NPI assigned
- Feb 11, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 010188 | NY | Primary |
Addresses
Primary practice location
10 Grace Ave
Suite 6
Great Neck, NY 11021-2423
Mailing address
10 Grace Ave
Suite 6
Great Neck, NY 11021-2423
Phone (516) 829-5982
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01350141 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 7, 2021 through Apr 7, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozanam Hall of Queens Nursing Home, Inc | 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.
-
- Skilled Nursing Facility
- Bayside, NY
- NPI 1396825543
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1609917608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 GRACE AVE",
"address_2": "SUITE 6",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110212423",
"telephone_number": "516-829-5982"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 GRACE AVE",
"address_2": "SUITE 6",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110212423",
"telephone_number": "516-829-5982"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARRELL",
"first_name": "ROBERT",
"middle_name": "ALFRED",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-11",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "010188",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01350141",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Great Neck, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.