Individual provider Active NPI

Roberta Saletsky, PH.D.

  • Clinical Psychologist
  • Syracuse, NY
National Provider Identifier
1821014200
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
011006-1 Issued in NY
Practice address
750 E Adams St
Syracuse, NY 13210-2306
Phone
(315) 464-3115
NPI assigned
Jul 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 011006-1 NY Primary

Addresses

Primary practice location

750 E Adams St
Syracuse, NY 13210-2306

Mailing address

750 E Adams St
Syracuse, NY 13210-2306
Phone (315) 464-3115

Other identifiers 1

IdentifierTypeStateIssuer
01501808MedicaidNY

Other names 1

  • Roberta Tanenbaum Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061020000170 NY Practitioner - Clinical Psychologist 5597761262 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

550 Harrison St
Syracuse, NY 13202-3188
Phone (315) 464-8093

750 E Adams St
Syracuse, NY 13210-2306
Phone (315) 464-8093

Merit-based Incentive Payment System (MIPS)

Final score
88.04 of 100Reported as group
Quality
67.92
Promoting interoperability
99
Improvement activities
40
Cost
69.19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
011006-1NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Psychiatry Faculty Practice, Inc. Clinical CurrentSince Jan 15, 2018 Accepting new patients
Suny Health Science Center at Syracuse CurrentSince Jun 1, 2022 Accepting new patients
Suny Health Science Center at Syracuse CurrentSince Jun 1, 2022 Accepting new patients
Professional Practice Group, Dept. of Psych Clinical Past Accepting new patients

Locations

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

713 Harrison St
Syracuse, NY 13210
Phone (315) 464-3145

713 Harrison St
#3
Syracuse, NY 13210
Phone (315) 464-3119

713 Harrison St
Bldg 3
Syracuse, NY 13210
Phone (315) 464-3265

Interoperability endpoints

  • Direct secure messaging: rsaletsky7148@direct.upstate.edu

Organizations & group practices 4

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821014200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-464-3115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-464-3115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALETSKY",
        "first_name": "ROBERTA",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "011006-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01501808",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROBERTA",
            "last_name": "TANENBAUM",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.