Individual provider Active NPI

Joanne Shea, PH.D.

  • Clinical Psychologist
  • Woodbury, NY
National Provider Identifier
1669494886
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
009557-1 Issued in NY
Practice address
378 Syosset Woodbury Rd
Woodbury, NY 11797-1200
Phone
(516) 921-3900
NPI assigned
Jul 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 009557-1 NY Primary

Addresses

Primary practice location

378 Syosset Woodbury Rd
Woodbury, NY 11797-1200

Mailing address

1 Old Country Rd
Suite 271
Carle Place, NY 11514-1801
Phone (800) 725-6280

Other identifiers 1

IdentifierTypeStateIssuer
01819378MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080826000080 NY Practitioner - Clinical Psychologist 8527133529 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
009557-1NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Che Senior Psychological Services, PC Clinical CurrentSince Nov 15, 2013 Accepting new patients

Locations

250 Beach 17th St
Far Rockaway, NY 11691
Phone (516) 670-0212

135 Vanderbilt Ave
Staten Island, NY 10304
Phone (718) 447-0101

378 Syosset Woodbury Rd
Woodbury, NY 11797
Phone (516) 622-7784

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669494886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 OLD COUNTRY RD",
            "address_2": "SUITE 271",
            "city": "CARLE PLACE",
            "state": "NY",
            "postal_code": "115141801",
            "telephone_number": "800-725-6280",
            "fax_number": "800-725-6380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "378 SYOSSET WOODBURY RD",
            "city": "WOODBURY",
            "state": "NY",
            "postal_code": "117971200",
            "telephone_number": "516-921-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEA",
        "first_name": "JOANNE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "009557-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01819378",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, NY

Sources for this page

Verify at the official NPI Registry.