Individual provider Active NPI

Dennis Fagundo-Ojeda, PHD

  • Clinical Psychologist
  • Bronx, NY
National Provider Identifier
1720628399
Registry record updated Dec 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY5000502 Issued in MA
Practice address
1200 Waters PL Ste 310
Bronx, NY 10461-2727
Phone
(617) 744-8542
NPI assigned
Jan 13, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY5000502 MA Primary
Clinical Psychologist 103TC0700X 027485 NY

Addresses

Primary practice location

1200 Waters PL Ste 310
Bronx, NY 10461-2727

Mailing address

20 Halletts PT Apt 1010
Astoria, NY 11102-5094
Phone (787) 560-4861

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY5000502MAMDClinical Psychologist
027485NYMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766016000000",
    "number": "1720628399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 HALLETTS PT APT 1010",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111025094",
            "telephone_number": "787-560-4861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 WATERS PL STE 310",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612727",
            "telephone_number": "617-744-8542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGUNDO-OJEDA",
        "first_name": "DENNIS",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-13",
        "last_updated": "2025-12-18",
        "certification_date": "2025-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "PSY5000502",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "027485",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2025; 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.