Individual provider Active NPI

Lawrence Edward Dresdale, PH.D.

  • Psychologist
  • Kingston, NY
National Provider Identifier
1689791352
Registry record updated Aug 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
007948 Issued in NY
Practice address
159 Green St.
Suite 1
Kingston, NY 12401
Phone
(845) 339-2352
Fax
(845) 339-2382
NPI assigned
Mar 26, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 25, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 007948 NY Primary

Addresses

Primary practice location

159 Green St.
Suite 1
Kingston, NY 12401

Mailing address

721 Broadway # 201
Kingston, NY 12401-3449
Phone (845) 331-2007

Other practice location 1

159 Green St.
Suite 1
Kingston, NY 12401-3737
Phone (845) 339-2352 ext. 1

Other identifiers 3

IdentifierTypeStateIssuer
00977344MedicaidNY
986103OtherNYMVP HEALTHCARE
135390OtherNYVALUEOPTIONS

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
I20101209000640 NY Practitioner - Clinical Psychologist 7214124767 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

721 Broadway
Suite 201
Kingston, NY 12401-3449
Phone (845) 331-2007

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Catskill Mountain Psychology PLLC CurrentSince Jul 1, 2015 Accepting new patients
Michael Schwalberg, PH.D., Psychologist, PLLC PastSince Oct 12, 2010 Accepting new patients

Locations

159 Green St
Kingston, NY 12401
Phone (845) 331-2007

159 Green St
Ste 1
Kingston, NY 12401
Phone (845) 338-3250

721 Broadway
#201
Kingston, NY 12401
Phone (845) 331-2007

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": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535155200000",
    "number": "1689791352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 BROADWAY # 201",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124013449",
            "telephone_number": "845-331-2007",
            "fax_number": "845-339-2382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 GREEN ST.",
            "address_2": "SUITE 1",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "12401",
            "telephone_number": "845-339-2352",
            "fax_number": "845-339-2382"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "159 Green St.",
            "address_2": "Suite 1",
            "address_purpose": "LOCATION",
            "city": "Kingston",
            "state": "NY",
            "postal_code": "124013737",
            "country_code": "US",
            "telephone_number": "845-339-2352 x1",
            "fax_number": "845-339-2382",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DRESDALE",
        "first_name": "LAWRENCE",
        "middle_name": "EDWARD",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-26",
        "last_updated": "2018-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "007948",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00977344",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP HEALTHCARE",
            "identifier": "986103",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUEOPTIONS",
            "identifier": "135390",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, NY

Sources for this page

Verify at the official NPI Registry.