Wellness Road Psychology, PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

WELLNESS ROAD PSYCHOLOGY, PLLC

Practice address

140 Broadway # 4657
New York, NY 10005-1108

Phone

(646) 961-4973

NPI assigned

Jan 21, 2020

Last updated

Jan 21, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Philip Glickman, PSYDNPI 1942597166

Title

Owner/Psychologist

Phone

(646) 961-4973

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Philip Adrian Glickman, PSY.D.

  • Clinical Psychologist
  • New York, NY
  • NPI 1942597166
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1639709439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 N ECKAR ST",
            "city": "IRVINGTON",
            "state": "NY",
            "postal_code": "105331510",
            "telephone_number": "914-671-4860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 BROADWAY # 4657",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100051108",
            "telephone_number": "646-961-4973"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "145 Palisade St",
            "address_purpose": "LOCATION",
            "city": "Dobbs Ferry",
            "state": "NY",
            "postal_code": "105221617",
            "country_code": "US",
            "telephone_number": "646-961-4973",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WELLNESS ROAD PSYCHOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-21",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "GLICKMAN",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_title_or_position": "OWNER/PSYCHOLOGIST",
        "authorized_official_telephone_number": "646-961-4973",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in New York, NY
• Providers in New York, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.