Jessica Lee Nusbaum, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

022689 Issued in NY

Practice address

7403 Commonwealth Blvd BLDG 55
Bellerose, NY 11426-1839

Phone

(718) 264-4574

NPI assigned

Sep 21, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1632182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1891466819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7403 COMMONWEALTH BLVD BLDG 57",
            "city": "BELLEROSE",
            "state": "NY",
            "postal_code": "114261839",
            "telephone_number": "718-264-4574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7403 COMMONWEALTH BLVD BLDG 55",
            "city": "BELLEROSE",
            "state": "NY",
            "postal_code": "114261839",
            "telephone_number": "718-264-4574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUSBAUM",
        "first_name": "JESSICA",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-21",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "022689",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "022689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• New York City Childrens Center
• New York City Department of Education
• Nex Gen Care LLC
• Next Gen Health LLC
• Nurse Practitioner in Family Health, Health Care Solutions, PLLC
• Nys Office of Mental Health
• Nys Office of Mental Health
• Nys Office of Mental Health
• Nysadc Incorporated
• Mary T. O'Leary, RN BS

• Clinical Psychologist in Bellerose, NY
• Providers in Bellerose, 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 Nov 18, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.