Debra K Smith, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

010974 Issued in NY

Practice address

200 Belle Terre Rd
Port Jefferson, NY 11777-1928

Phone

(631) 474-6000

NPI assigned

Aug 9, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Psychologist

Education

State University of New York at Stony Brook, School of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northside Psychology PLLCGroup PAC ID 5193117570, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Northside Psychology PLLC

  • Psychologist
  • Brooklyn, NY
  • NPI 1477058998
  Medicare reassignment Care Compare group NPD
• Dove Psychiatry- NP in Psychiatry, PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • South Setauket, NY
  • NPI 1811783913
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720089972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BELLE TERRE RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771928",
            "telephone_number": "631-474-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BELLE TERRE RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771928",
            "telephone_number": "631-474-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "DEBRA",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "010974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda R Skelly, CF-SLP
• Jeffrey C Skillman, LMSW
• Jennifer Ann Skula, RN
• Patricia Slokovitz
• Claire Smith, NPP
• Jacob Detlef Sokol, MD
• Lauren Elizabeth Solliday, AU.D.
• Sonic Technical Services Inc
• Sophia Manolis DDS P.C.
• Christopher Sorce

• Clinical Psychologist in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.