Keri Boylan Petrone, PSYD, PSYD.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5634 Issued in NJ

Practice address

482 Springfield Ave
Summit, NJ 07901-2601

Phone

(908) 273-5558

NPI assigned

Sep 11, 2016

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Om Psychological Services

  • Clinical Psychologist
  • Summit, NJ
  • NPI 1073474466
  NPD

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

{
    "created_epoch": "1473552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473552000000",
    "number": "1720536451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "482 SPRINGFIELD AVE",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079012601",
            "telephone_number": "908-273-5558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "482 SPRINGFIELD AVE",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079012601",
            "telephone_number": "908-273-5558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRONE, PSYD",
        "first_name": "KERI",
        "middle_name": "BOYLAN",
        "name_prefix": "Dr.",
        "credential": "PSYD.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-11",
        "last_updated": "2016-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "5634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olivia Jane Perlmutter, M.S
• Kristen G. Perman, L.AC, C.A.
• Brian A Peterkin, PA-C
• Melanie Ann Peters, LPC, ATR-BC
• Elijah Peterson, MD
• Zachary John Petrucci, MD
• Meryl Pfeiffer, LPC
• Brendan Phillips, OTR/L
• Anna M Pickton, MS CCC-SLP
• James Pierre-Louis, MD

• Clinical Psychologist in Summit, NJ
• Providers in Summit, NJ by specialty
• Clinical Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.