Active NPI
Gary Richard Altheim, PSY.D.
- Clinical Psychologist
- South Salem, NY
National Provider Identifier
1740639038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 012506-1
- Practice address
- 199 Kitchawan Rd
South Salem, NY 10590-2016 - Phone
- (917) 533-6880
- NPI assigned
- Jun 7, 2016
- Last updated
- Jun 7, 2016
- Sex
- Male
- 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 | 012506-1 | NY | Primary |
Addresses
Primary practice location
199 Kitchawan Rd
South Salem, NY 10590-2016
Mailing address
199 Kitchawan Rd
South Salem, NY 10590-2016
Phone (917) 533-6880
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012506 | NY | MD | Chiropractor |
| 012506-1 | NY | MD | Occupational Therapist |
Interoperability endpoints
- cpa.garyaltheim@142175.advancedmd-direct.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465257600000",
"number": "1740639038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "199 KITCHAWAN RD",
"city": "SOUTH SALEM",
"state": "NY",
"postal_code": "105902016",
"telephone_number": "917-533-6880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "199 KITCHAWAN RD",
"city": "SOUTH SALEM",
"state": "NY",
"postal_code": "105902016",
"telephone_number": "917-533-6880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALTHEIM",
"first_name": "GARY",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-07",
"last_updated": "2016-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "012506-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Salem, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.