Active NPI
Mary Joseph Kollappallil, PH.D
- Clinical Psychologist
- Jamaica, NY
National Provider Identifier
1730404740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 017693
- Practice address
- 15011 Hillside Ave
2ND Floor
Jamaica, NY 11432-3319 - Phone
- (718) 739-5778
- Fax
- (718) 523-2728
- NPI assigned
- Apr 1, 2010
- Sex
- Female
- Sole proprietor
- No
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 | 017693 | NY | Primary |
Addresses
Primary practice location
15011 Hillside Ave
2ND Floor
Jamaica, NY 11432-3319
Mailing address
15011 Hillside Ave
2ND Floor
Jamaica, NY 11432-3319
Phone (718) 739-5778
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270080000000",
"number": "1730404740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15011 HILLSIDE AVE",
"address_2": "2ND FLOOR",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114323319",
"telephone_number": "718-739-5778",
"fax_number": "718-523-2728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15011 HILLSIDE AVE",
"address_2": "2ND FLOOR",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114323319",
"telephone_number": "718-739-5778",
"fax_number": "718-523-2728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLLAPPALLIL",
"first_name": "MARY",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-04-01",
"last_updated": "2010-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "017693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamaica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2010; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.