Active NPI
Judy Chang Gummelt, PSY.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1891907358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 010366-1
- Practice address
- 16 E 79TH St
4-1
New York, NY 10075-0150 - Phone
- (212) 861-4783
- NPI assigned
- May 4, 2007
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 010366-1 | NY | Primary |
| Clinical Psychologist | 103TC0700X | PSY18086 | CA | |
| Clinical Psychologist | 103TC0700X | 1836 | OR |
Addresses
Primary practice location
16 E 79TH St
4-1
New York, NY 10075-0150
Mailing address
16 E 79TH St
4-1
New York, NY 10075-0150
Phone (212) 861-4783
Other names 1
- Dr. Judy P Chang
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 5, 2017 through Jan 5, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY18086 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272412800000",
"number": "1891907358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 E 79TH ST",
"address_2": "4-1",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100750150",
"telephone_number": "212-861-4783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16 E 79TH ST",
"address_2": "4-1",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100750150",
"telephone_number": "212-861-4783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUMMELT",
"first_name": "JUDY",
"middle_name": "CHANG",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-04",
"last_updated": "2010-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "010366-1",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY18086",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "1836",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JUDY",
"last_name": "CHANG",
"middle_name": "P",
"prefix": "DR.",
"credential": "PSY.D.",
"code": "5",
"type": "Other Name"
}
]
}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 Apr 28, 2010; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.