Nicholas Tebrake
Individual provider Active NPI Psychologist · Briarcliff, NY
NPI 1760262174 · NPPES record last updated Oct 3, 2023
Key facts
- NPI
- 1760262174
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 025699-01 (NY)
- Practice address
- 445 N State Rd Ste 2
Briarcliff, NY 10510-1460 - Phone
- (914) 582-4177
- NPI assigned
- Oct 3, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 025699-01 | NY | MD | Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 025699-01 | NY | Yes |
Addresses
Primary practice location
445 N State Rd Ste 2
Briarcliff, NY 10510-1460
Mailing address
31 Watson Ave
Ossining, NY 10562-4423
Phone (914) 582-4177
Other names
- Nick Tebrake
Other providers in Briarcliff, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.