Active NPI
James Nelson Bowers Dillard, PSY.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1811196579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 013205
- Practice address
- 220 Manhattan Ave Apt 6F
New York, NY 10025-2666 - Phone
- (917) 653-6677
- NPI assigned
- Jul 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | 013205 | NY | |
| Adult Development & Aging Psychologist | 103TA0700X | 013205 | NY | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 013205 | NY | |
| Clinical Psychologist | 103TC0700X | 013205 | NY | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 013204 | NY | |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 013205 | NY |
Addresses
Primary practice location
220 Manhattan Ave Apt 6F
New York, NY 10025-2666
Mailing address
220 Manhattan Ave Apt 6F
New York, NY 10025-2666
Phone (917) 653-6677
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 013205 | Other | NY | PSYCHOLOGY LICENSE STATE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 7, 2022 through Dec 7, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013204 | NY | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184284800000",
"number": "1811196579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 MANHATTAN AVE APT 6F",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100252666",
"telephone_number": "917-653-6677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 MANHATTAN AVE APT 6F",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100252666",
"telephone_number": "917-653-6677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DILLARD",
"first_name": "JAMES",
"middle_name": "NELSON BOWERS",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-13",
"last_updated": "2007-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "NY",
"license": "013205",
"primary": false
},
{
"code": "103TA0700X",
"taxonomy_group": "",
"desc": "Psychologist, Adult Development & Aging",
"state": "NY",
"license": "013205",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "NY",
"license": "013205",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "013205",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NY",
"license": "013204",
"primary": false
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "NY",
"license": "013205",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGY LICENSE STATE",
"identifier": "013205",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.