NPIMap

Organization Active NPI

Red Door Individualized Learning Program LLC

  • Cognitive & Behavioral Psychologist
  • Hempstead, NY
National Provider Identifier
1821768375
Registry record updated Sep 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
Legal business name
RED DOOR INDIVIDUALIZED LEARNING PROGRAM LLC
Practice address
30 W Columbia St
Hempstead, NY 11550-2411
Phone
(516) 385-2323
Fax
(516) 481-4201
NPI assigned
Sep 16, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2021

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

Authorized official

Name
Mr. Gregory Domond
Title
President
Phone
(516) 654-8600

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X Primary
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X
Community/Behavioral Health Agency 251S00000X
Developmental Disabilities Clinic/Center 261QD1600X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

30 W Columbia St
Hempstead, NY 11550-2411

Mailing address

30 W Columbia St
Hempstead, NY 11550-2411
Phone (516) 385-2323

National Provider Directory

National Provider Directory

Locations

30 W Columbia St
Hempstead, NY 11550
Phone (516) 385-2323

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1631750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1821768375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 W COLUMBIA ST",
            "city": "HEMPSTEAD",
            "state": "NY",
            "postal_code": "115502411",
            "telephone_number": "516-385-2323",
            "fax_number": "516-481-4201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 W COLUMBIA ST",
            "city": "HEMPSTEAD",
            "state": "NY",
            "postal_code": "115502411",
            "telephone_number": "516-385-2323",
            "fax_number": "516-481-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED DOOR INDIVIDUALIZED LEARNING PROGRAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-16",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A",
        "authorized_official_last_name": "DOMOND",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-654-8600",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hempstead, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.

Verify at the official NPI Registry.