Phyllis Broege, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

013412 Issued in NY

Practice address

2 Country Club Rd
Queensbury, NY 12804-1702

Phone

(518) 926-2000

Fax

(518) 926-2020

NPI assigned

Oct 12, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573603200000",
    "number": "1669460762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PARK ST",
            "address_2": "GLENS FALLS HOSPITAL",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128014413",
            "telephone_number": "518-926-7200",
            "fax_number": "518-926-7036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 COUNTRY CLUB RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128041702",
            "telephone_number": "518-926-2000",
            "fax_number": "518-926-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROEGE",
        "first_name": "PHYLLIS",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-12",
        "last_updated": "2019-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "013412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "680014530",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02070735",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Courtney Paige Brimmer
• Kelly Brock, BCBA
• Krysta L Brown-Klochaney, PNP
• Shauna M Brown-Knobel, NCBT, MSED
• Amber May Brown, RN
• Denise Rene Brown, LMHC
• Jennifer Brueckner

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 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.

Verify at the official NPI Registry.