NPIMap

Individual provider Active NPI

Roy Nisenson, PHD MDIV

  • Psychologist
  • New Haven, CT
National Provider Identifier
1679584882
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
00678 Issued in CT
Practice address
28 Academy St
New Haven, CT 06511-6930
Phone
(203) 497-8320
NPI assigned
Aug 11, 2006
Sex
Male
Sole proprietor
Yes

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
Psychologist 103T00000X 00678 CT Primary

Addresses

Primary practice location

28 Academy St
New Haven, CT 06511-6930

Mailing address

28 Academy St
New Haven, CT 06511-6930
Phone (203) 497-8320

Other identifiers 4

IdentifierTypeStateIssuer
018704OtherHEALTHNET
ZS381OtherOXFORD
060000678CT05OtherCTANTHEM
108432OtherVALUE OPTIONS

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
00678CTMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Physical Therapy of Southern New England LLC Past Accepting new patients
Select Behavioral Health, LLC PastSince Jan 1, 1999 Accepting new patients
On-Site Psychological Services PC Past Accepting new patients
Medical Network Services PC Past Accepting new patients

Organizations & group practices 4

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": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679584882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 ACADEMY ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065116930",
            "telephone_number": "203-497-8320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 ACADEMY ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065116930",
            "telephone_number": "203-497-8320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISENSON",
        "first_name": "ROY",
        "credential": "PHD MDIV",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CT",
            "license": "00678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "018704",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "ZS381",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "060000678CT05",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "108432",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.