Active NPI
Bethany L Moon, M.A., S.S.P.
- School Psychologist
- Queensbury, NY
National Provider Identifier
1902255433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 2695385
- Practice address
- 11 Thistlewood Dr
Queensbury, NY 12804-9352 - Phone
- (518) 307-1825
- NPI assigned
- Jun 6, 2016
- Last updated
- Jun 6, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 2695385 | NY | Primary |
Addresses
Primary practice location
11 Thistlewood Dr
Queensbury, NY 12804-9352
Mailing address
11 Thistlewood Dr
Queensbury, NY 12804-9352
Phone (518) 307-1825
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
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2695385 | NY | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465171200000",
"number": "1902255433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 THISTLEWOOD DR",
"city": "QUEENSBURY",
"state": "NY",
"postal_code": "128049352",
"telephone_number": "518-307-1825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 THISTLEWOOD DR",
"city": "QUEENSBURY",
"state": "NY",
"postal_code": "128049352",
"telephone_number": "518-307-1825"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "BETHANY",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "M.A., S.S.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-06",
"last_updated": "2016-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "NY",
"license": "2695385",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Queensbury, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.