Evan R Podolak, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

018395-1 Issued in NY

Practice address

1600 Harrison Ave
Suite 307B
Mamaroneck, NY 10543-3145

Phone

(914) 835-3910

NPI assigned

Jan 6, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective May 1, 2019 through May 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1262736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273104000000",
    "number": "1831429240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 FENIMORE DR",
            "city": "HARRISON",
            "state": "NY",
            "postal_code": "105281413",
            "telephone_number": "914-714-3108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 HARRISON AVE",
            "address_2": "SUITE 307B",
            "city": "MAMARONECK",
            "state": "NY",
            "postal_code": "105433145",
            "telephone_number": "914-835-3910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PODOLAK",
        "first_name": "EVAN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-01-06",
        "last_updated": "2010-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "018395-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Pierrette
• Daniel J Pietrzak, COTA
• Deborah Nancy Plachta, MD
• Regine Plummer, LMHC
• PM Pediatrics of Mamaroneck
• Renata Podolec
• Danielle Marie Pomeroy, OM, NYCPS-P, FPA
• Julia Poniros
• Laurie Posner, MD
• Heather Powers

• Clinical Psychologist in Mamaroneck, NY
• Providers in Mamaroneck, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.