Active NPI
Jessa Dmytryszyn, MSCP
- Clinical Psychologist
- Detroit, MI
National Provider Identifier
1649659269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6361003261
- Practice address
- 4160 Woodward Ave
2ND Floor
Detroit, MI 48201-2027 - Phone
- (313) 656-4052
- NPI assigned
- May 28, 2015
- Last updated
- Jan 7, 2021
- Sex
- Female
- Sole proprietor
- No
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 | 6361003261 | MI | Primary |
Addresses
Primary practice location
4160 Woodward Ave
2ND Floor
Detroit, MI 48201-2027
Mailing address
2304 Progress Ave
Lincoln Park, MI 48146-4808
Phone (734) 626-1824
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jdmytryszyn@thechildrenscenter.com |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inpsych Evaluation Services LLC | Current | Accepting new patients | |
| Imagine Center LLC | Clinical | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Trenton, MI
- NPI 1831812684
-
- Clinical Psychologist
- Northville, MI
- NPI 1467899666
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609977600000",
"number": "1649659269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2304 PROGRESS AVE",
"city": "LINCOLN PARK",
"state": "MI",
"postal_code": "481464808",
"telephone_number": "734-626-1824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4160 WOODWARD AVE",
"address_2": "2ND FLOOR",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012027",
"telephone_number": "313-656-4052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DMYTRYSZYN",
"first_name": "JESSA",
"credential": "MSCP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-28",
"last_updated": "2021-01-07",
"certification_date": "2021-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6361003261",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jdmytryszyn@thechildrenscenter.com",
"affiliation": "N",
"address_1": "4160 Woodward Ave",
"address_2": "2nd floor",
"city": "Detroit",
"state": "MI",
"country_code": "US",
"postal_code": "482012027",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 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.