Johanna Lyn Sangemino, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

024249 Issued in NY

Practice address

101 6TH Ave FL 8
New York, NY 10013-1905

Phone

(917) 580-7395

NPI assigned

Feb 18, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Johanna Lyn Terry Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Mindful Living Psychological Services, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Patchogue, NY
  • NPI 1144951393
  NPD Authorized official

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

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1639762867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 E SUNRISE HWY # 1028",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117721906",
            "telephone_number": "631-517-3251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 6TH AVE FL 8",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100131905",
            "telephone_number": "917-580-7395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANGEMINO",
        "first_name": "JOHANNA",
        "middle_name": "LYN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-18",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "024249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHANNA",
            "last_name": "TERRY",
            "middle_name": "LYN",
            "prefix": "DR.",
            "credential": "PSY.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laura Sanford, MS, RD, CDN, CNSC
• Marie V Sanford, MD
• Anna Sang
• Assata Sangare
• Aliya Sange
• Joseph Sanger, M.D.
• Gurtej Singh Sangha, MD
• Jasmair Singh Sangha, MD
• Bharat Sanghavi, MD
• Moushumi B Sanghavi, M.D.

• 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 Aug 4, 2023; 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.