Active NPI
Jean Petrucelli, PH.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1861801441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 009736-1
- Practice address
- 470 W End Ave # 1Aa
New York, NY 10024-4933 - Phone
- (212) 724-9447
- Fax
- (212) 724-6269
- NPI assigned
- Aug 7, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychoanalyst | 102L00000X | |||
| Clinical Psychologist | 103TC0700X | 009736-1 | NY | Primary |
Addresses
Primary practice location
470 W End Ave # 1Aa
New York, NY 10024-4933
Mailing address
470 W End Ave # 1Aa
New York, NY 10024-4933
Phone (212) 724-9447
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009736-1 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407369600000",
"number": "1861801441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "470 W END AVE # 1AA",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100244933",
"telephone_number": "212-724-9447",
"fax_number": "212-724-6269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "470 W END AVE # 1AA",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100244933",
"telephone_number": "212-724-9447",
"fax_number": "212-724-6269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRUCELLI",
"first_name": "JEAN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-08-07",
"last_updated": "2014-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "102L00000X",
"taxonomy_group": "",
"desc": "Psychoanalyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "009736-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.