George James Bouklas, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

011248 Issued in NY

Practice address

69A Gnarled Hollow Rd
East Setauket, NY 11733-2026

Phone

(631) 751-0092

Fax

(631) 689-6201

NPI assigned

Feb 5, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891834305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69A GNARLED HOLLOW RD",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117332026",
            "telephone_number": "631-751-0092",
            "fax_number": "631-689-6201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69A GNARLED HOLLOW RD",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117332026",
            "telephone_number": "631-751-0092",
            "fax_number": "631-689-6201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUKLAS",
        "first_name": "GEORGE",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "011248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01338949",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debra Bonamassa
• Janet Boppe
• Marisa Borek, NPP
• Mark Gregory Borek, M.D.
• Lindsay Bosch, M.S.
• Nariman Boyle, M.D.
• Ryan Bozzello, M.A. CCC-SLP
• Pilar Souviron Bracero
• Douglas L Brand, M.D.
• Lauren Brand, R.D.

• Clinical Psychologist in East Setauket, NY
• Providers in East Setauket, 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.