Individual provider Active NPI

Anya Genieser-Derosa, PSY.D.

  • Psychologist
  • Red Hill, PA
National Provider Identifier
1689767741
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PS015501 Issued in PA
Practice address
80 Gravel Pike Unit B
Red Hill, PA 18076-1428
Phone
(484) 624-2415
Fax
(215) 679-2875
NPI assigned
Oct 2, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral Psychologist 103TB0200X
Clinical Psychologist 103TC0700X PS015501 PA
Clinical Child & Adolescent Psychologist 103TC2200X
Group Psychotherapy Psychologist 103TP2701X
Specialist 174400000X
Psychologist 103T00000X PS015501 PA Primary

Addresses

Primary practice location

80 Gravel Pike Unit B
Red Hill, PA 18076-1428

Mailing address

1848 Candlewyck LN
Green Lane, PA 18054-2047
Phone (484) 624-2415

Other identifiers 1

IdentifierTypeStateIssuer
PS015501OtherPALICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20041021000498 PA Practitioner - Clinical Psychologist 4981665114 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

80 Gravel Pike
Suite B
Red Hill, PA 18076-1423
Phone (484) 624-2415

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Radiant Being Psychological Services, P.C. CurrentSince Mar 6, 2017 Accepting new patients

Locations

80 Gravel Pike
Ste B100
Red Hill, PA 18076
Phone (484) 624-2415

Organizations & group practices 1

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1689767741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1848 CANDLEWYCK LN",
            "city": "GREEN LANE",
            "state": "PA",
            "postal_code": "180542047",
            "telephone_number": "484-624-2415",
            "fax_number": "215-679-2875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 GRAVEL PIKE UNIT B",
            "city": "RED HILL",
            "state": "PA",
            "postal_code": "180761428",
            "telephone_number": "484-624-2415",
            "fax_number": "215-679-2875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENIESER-DEROSA",
        "first_name": "ANYA",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS015501",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS015501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PS015501",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Hill, PA

Sources for this page

Verify at the official NPI Registry.