Active NPI
Leah Bahadourian
- Clinical Psychologist
- Fresh Meadows, NY
National Provider Identifier
1679958318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 022433
- Practice address
- 6143 186TH St
Fresh Meadows, NY 11365-2710 - Phone
- (646) 653-3303
- NPI assigned
- Jul 23, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | P99778 | NY | |
| Clinical Psychologist | 103TC0700X | 022433 | NY | Primary |
Addresses
Primary practice location
6143 186TH St
Fresh Meadows, NY 11365-2710
Mailing address
6143 186TH St
Fresh Meadows, NY 11365-2710
Phone (646) 653-3303
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P99778 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670284800000",
"number": "1679958318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6143 186TH ST",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "113652710",
"telephone_number": "646-653-3303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6143 186TH ST",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "113652710",
"telephone_number": "646-653-3303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAHADOURIAN",
"first_name": "LEAH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-23",
"last_updated": "2022-12-06",
"certification_date": "2022-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "P99778",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "022433",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresh Meadows, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.