Organization Active NPI

Christine a Marra Psychologist PLLC

  • Clinical Psychologist
  • Albany, NY
National Provider Identifier
1851636104
Registry record updated Aug 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
014506-1 Issued in NY
Legal business name
CHRISTINE A MARRA PSYCHOLOGIST PLLC
Practice address
1 Marcus Blvd
Ste. 105
Albany, NY 12205-5953
Phone
(518) 587-0499
Fax
(518) 786-6467
NPI assigned
Nov 27, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2015

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

Authorized official

Name
Christine A Marra, PH.D.NPI 1043238785
Title
Sole Member
Phone
(518) 587-0499

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 014506-1 NY Primary

Addresses

Primary practice location

1 Marcus Blvd
Ste. 105
Albany, NY 12205-5953

Mailing address

55 S Angell St
Providence, RI 02906-5206
Phone (518) 587-0499

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190521000902 NY Part B Supplier - Clinic/Group Practice 1759534605 Receives reassigned benefits from 1 practitioner
Practice locations: West Sayville, NY

National Provider Directory

National Provider Directory

Locations

1 Marcus Blvd
Ste 105
Albany, NY 12205
Phone (518) 482-7666

55 S Angell St
Providence, RI 02906
Phone (401) 648-8922

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": "1353974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439424000000",
    "number": "1851636104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 S ANGELL ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029065206",
            "telephone_number": "518-587-0499",
            "fax_number": "518-786-6467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MARCUS BLVD",
            "address_2": "STE. 105",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122055953",
            "telephone_number": "518-587-0499",
            "fax_number": "518-786-6467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTINE A MARRA PSYCHOLOGIST PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-27",
        "last_updated": "2015-08-13",
        "status": "A",
        "authorized_official_last_name": "MARRA",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "518-587-0499",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "014506-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.