Active NPI
Donna Yeisley, PHD
- Clinical Psychologist
- Fairfield, CT
National Provider Identifier
1609956796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 002871
- Practice address
- 2335 Black Rock Tpke
Fairfield, CT 06825-3220 - Phone
- (203) 362-9556
- Fax
- (203) 372-7596
- NPI assigned
- Oct 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 002871 | CT | Primary |
| Clinical Psychologist | 103TC0700X | 013314 | NY |
Addresses
Primary practice location
2335 Black Rock Tpke
Fairfield, CT 06825-3220
Mailing address
2335 Black Rock Tpke
Fairfield, CT 06825-3220
Phone (203) 362-9556
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02009929 | Medicaid | NY |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013314 | NY | MD | Clinical Psychologist |
| 002871 | CT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244592000000",
"number": "1609956796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2335 BLACK ROCK TPKE",
"city": "FAIRFIELD",
"state": "CT",
"postal_code": "068253220",
"telephone_number": "203-362-9556",
"fax_number": "203-372-7596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2335 BLACK ROCK TPKE",
"city": "FAIRFIELD",
"state": "CT",
"postal_code": "068253220",
"telephone_number": "203-362-9556",
"fax_number": "203-372-7596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YEISLEY",
"first_name": "DONNA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-16",
"last_updated": "2009-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "002871",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "013314",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02009929",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.