Active NPI
Jessica Lax, PSY.D.
- Clinical Psychologist
- Philadelphia, PA
National Provider Identifier
1649615170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS018819
- Practice address
- 10541 Drummond Rd
Philadelphia, PA 19154 - Phone
- (215) 612-7573
- Fax
- (215) 632-6426
- NPI assigned
- May 10, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS018819 | PA | Primary |
Addresses
Primary practice location
10541 Drummond Rd
Philadelphia, PA 19154
Mailing address
2005 Cabot Blvd W
Langhorne, PA 19047-1885
Other practice location 1
1517 Durham Rd
Penndel, PA 19047-5707
Phone (215) 752-1541
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23-1742920 | Medicaid | PA |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS018819 | PA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Penndel Mental Health Center, Inc. | Past | Accepting new patients | |
| Special People in Northeast, Inc. | Past | Accepting new patients | |
| Penndel Mental Health Center | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Langhorne, PA
- NPI 1104096973
-
- Community/Behavioral Health Agency
- Penndel, PA
- NPI 1710019096
-
- Community/Behavioral Health Agency
- Philadelphia, PA
- NPI 1013044304
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563753600000",
"number": "1649615170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2005 CABOT BLVD W",
"city": "LANGHORNE",
"state": "PA",
"postal_code": "190471885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10541 DRUMMOND RD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19154",
"telephone_number": "215-612-7573",
"fax_number": "215-632-6426"
}
],
"practiceLocations": [
{
"address_1": "1517 Durham Rd",
"address_purpose": "LOCATION",
"city": "Penndel",
"state": "PA",
"postal_code": "190475707",
"country_code": "US",
"telephone_number": "215-752-1541",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LAX",
"first_name": "JESSICA",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-10",
"last_updated": "2019-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS018819",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "23-1742920",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.