Active NPI
Kristina Hammoudeh
- Psychologist
- Dearborn, MI
National Provider Identifier
1760812820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6361002821
- Practice address
- 6 Parklane Blvd
Suite 695
Dearborn, MI 48126-2696 - Phone
- (313) 271-8170
- NPI assigned
- Nov 26, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301014382 | MI | |
| Psychologist | 103T00000X | 6361002821 | MI | Primary |
Addresses
Primary practice location
6 Parklane Blvd
Suite 695
Dearborn, MI 48126-2696
Mailing address
6 Parklane Blvd
Suite 695
Dearborn, MI 48126-2696
Phone (313) 271-8170
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6301014382 | Other | MI | LICENCE |
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 |
|---|---|---|---|
| 6361002821 | MI | MD | Psychologist |
| 6301014382 | MI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Richard Kneip, PH.D., P.C. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Clarkston, MI
- NPI 1679739700
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1385424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683158400000",
"number": "1760812820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 PARKLANE BLVD",
"address_2": "SUITE 695",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481262696",
"telephone_number": "313-271-8170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6 PARKLANE BLVD",
"address_2": "SUITE 695",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481262696",
"telephone_number": "313-271-8170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAMMOUDEH",
"first_name": "KRISTINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-11-26",
"last_updated": "2023-05-04",
"certification_date": "2023-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301014382",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6361002821",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENCE",
"identifier": "6301014382",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.