Dijana Blacic, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

016908-1 Issued in NY

Practice address

160 Howells Rd Ste 2
Bay Shore, NY 11706-5320

Phone

(631) 647-7885

Fax

(631) 647-7893

NPI assigned

Oct 24, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Stillwater Occupational Therapy & Social Work Group, PLLC

  • Occupational Therapist
  • Bay Shore, NY
  • NPI 1154384287
  NPD (past)

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188864000000",
    "number": "1669555389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 HOWELLS RD STE 2",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117065320",
            "telephone_number": "631-647-7885",
            "fax_number": "631-647-7893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 HOWELLS RD STE 2",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117065320",
            "telephone_number": "631-647-7885",
            "fax_number": "631-647-7893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACIC",
        "first_name": "DIJANA",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2007-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "016908-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shantay Betty-Denton, SPECIAL EDUCATOR
• Leslie Anne Bial, SLP
• Edna Marisela Biancaniello, AGACNP
• Katherine Bideaux
• Michael Joseph Biondo
• Kevin Blair, PA
• Kimberly Blair, LMHC
• Anastasia Blanchard, NPP
• Edison Roque Blanco, M.D.
• Sophie Blanco, LMSW

• Clinical Psychologist in Bay Shore, NY
• Providers in Bay Shore, 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 Sep 4, 2007; 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.