Active NPI
Debra Dianne Domenech-Ristorucci
- Clinical Psychologist
- Astoria, NY
National Provider Identifier
1821673971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 010007
- Practice address
- 1842 21St Rd
Astoria, NY 11105-3940 - Phone
- (917) 698-2902
- NPI assigned
- Mar 10, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | 010007 | NY | Primary |
Addresses
Primary practice location
1842 21St Rd
Astoria, NY 11105-3940
Mailing address
1842 21St Rd
Astoria, NY 11105-3940
Phone (917) 698-2902
Other practice location 1
2920 Broadway Alfred Lerner Hall Columbia University
8th floor
New York, NY 10027
Phone (212) 854-2878
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010007 | Other | NY | PSYCHOLOGIST LICENSE |
| 010007 | Other | NY | PSYCHOLOGIST LICENSE |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615334400000",
"number": "1821673971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1842 21ST RD",
"city": "ASTORIA",
"state": "NY",
"postal_code": "111053940",
"telephone_number": "917-698-2902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1842 21ST RD",
"city": "ASTORIA",
"state": "NY",
"postal_code": "111053940",
"telephone_number": "917-698-2902"
}
],
"practiceLocations": [
{
"address_1": "2920 Broadway Alfred Lerner Hall Columbia University",
"address_2": "8th floor",
"address_purpose": "LOCATION",
"city": "New York",
"state": "NY",
"postal_code": "10027",
"country_code": "US",
"telephone_number": "212-854-2878",
"fax_number": "212-854-9473",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DOMENECH-RISTORUCCI",
"first_name": "DEBRA",
"middle_name": "DIANNE",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-10",
"last_updated": "2021-03-10",
"certification_date": "2021-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "010007",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGIST LICENSE",
"identifier": "010007",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGIST LICENSE",
"identifier": "010007",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Astoria, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.