Fred Doulton

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

011164 Issued in NY

Practice address

102 Glen Cove Dr
Glen Head, NY 11545-1715

Phone

(516) 551-5493

NPI assigned

Mar 16, 2021

Last updated

Mar 16, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: fdoulton@seafieldcenter.com

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

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615852800000",
    "number": "1639754138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 GLEN COVE DR",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "115451715",
            "telephone_number": "516-551-5493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 GLEN COVE DR",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "115451715",
            "telephone_number": "516-551-5493"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 Main St",
            "address_purpose": "LOCATION",
            "city": "Mineola",
            "state": "NY",
            "postal_code": "115014000",
            "country_code": "US",
            "telephone_number": "516-747-5644 x1628",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOULTON",
        "first_name": "FRED",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-16",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "011164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "fdoulton@seafieldcenter.com",
            "affiliation": "Y",
            "endpointDescription": "Outpatient facility",
            "affiliationName": "Seafield Services, Inc.",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "110 Main St",
            "city": "Mineola",
            "state": "NY",
            "country_code": "US",
            "postal_code": "115014000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Glen Head, NY
• Providers in Glen Head, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; 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.