Individual provider Active NPI

Bonnie McCluskey, PH.D

  • Clinical Psychologist
  • Yaphank, NY
National Provider Identifier
1861410508
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
012002-1 Issued in NY
Practice address
14 Glover Dr
Yaphank, NY 11980-1204
Phone
(631) 852-4400
NPI assigned
Jul 18, 2006
Last updated
Jul 8, 2007By the provider in NPPES
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 012002-1 NY Primary

Addresses

Primary practice location

14 Glover Dr
Yaphank, NY 11980-1204

Mailing address

1 Old Country Rd
Suite 271
Carle Place, NY 11514-1801
Phone (800) 725-6280

Other identifiers 1

IdentifierTypeStateIssuer
01517688MedicaidNY

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
I20101130001412 NY Practitioner - Clinical Psychologist 0648466755 Practice locations: Riverhead, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

512 Fox Hill Dr
Calverton, NY 11933-9510

810 E Main St
Riverhead, NY 11901-2563
Phone 63120898482563

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
012002-1NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Peter F Wigg PSYD Psychologist PC Clinical PastSince Feb 1, 2018 Accepting new patients

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861410508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 OLD COUNTRY RD",
            "address_2": "SUITE 271",
            "city": "CARLE PLACE",
            "state": "NY",
            "postal_code": "115141801",
            "telephone_number": "800-725-6280",
            "fax_number": "800-725-6380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 GLOVER DR",
            "city": "YAPHANK",
            "state": "NY",
            "postal_code": "119801204",
            "telephone_number": "631-852-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLUSKEY",
        "first_name": "BONNIE",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "012002-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01517688",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yaphank, NY

Sources for this page

Verify at the official NPI Registry.