Active NPI
Gabriella Serruya-Green, PSYD
- Clinical Psychologist
- Philadelphia, PA
National Provider Identifier
1710154133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS016358
- Practice address
- 2400 Chestnut St
Suite 2203
Philadelphia, PA 19103-4316 - Phone
- (215) 913-1809
- NPI assigned
- May 14, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS016358 | PA | Primary |
Addresses
Primary practice location
2400 Chestnut St
Suite 2203
Philadelphia, PA 19103-4316
Mailing address
2400 Chestnut St
Suite 2203
Philadelphia, PA 19103-4316
Phone (215) 913-1809
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 |
|---|---|---|---|
| PS016358 | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401667200000",
"number": "1710154133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 CHESTNUT ST",
"address_2": "SUITE 2203",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191034316",
"telephone_number": "215-913-1809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 CHESTNUT ST",
"address_2": "SUITE 2203",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191034316",
"telephone_number": "215-913-1809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERRUYA-GREEN",
"first_name": "GABRIELLA",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-14",
"last_updated": "2014-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS016358",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.