Active NPI
Anthony Destefano
- School Psychologist
- Manorville, NY
National Provider Identifier
1710016902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- Practice address
- 3 Carriage Path
Manorville, NY 11949-2611 - Phone
- (631) 878-8304
- Fax
- (631) 878-8304
- NPI assigned
- Mar 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 001964-1 | NY | |
| School Psychologist | 103TS0200X | NY | Primary |
Addresses
Primary practice location
3 Carriage Path
Manorville, NY 11949-2611
Mailing address
3 Carriage Path
Manorville, NY 11949-2611
Phone (516) 443-9877
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001964-1 | NY | MD | Art Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207267200000",
"number": "1710016902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 CARRIAGE PATH",
"city": "MANORVILLE",
"state": "NY",
"postal_code": "119492611",
"telephone_number": "516-443-9877",
"fax_number": "718-777-5250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 CARRIAGE PATH",
"city": "MANORVILLE",
"state": "NY",
"postal_code": "119492611",
"telephone_number": "631-878-8304",
"fax_number": "631-878-8304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESTEFANO",
"first_name": "ANTHONY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-05",
"last_updated": "2008-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "001964-1",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "NY",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manorville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.