Active NPI
Phyllis Anne Carlson, PH.D.
- Clinical Psychologist
- Melville, NY
National Provider Identifier
1912145517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 5724
- Practice address
- 5 Leighton CT
Melville, NY 11747-3910 - Phone
- (631) 495-7254
- NPI assigned
- Feb 4, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 5724 | NY | Primary |
Addresses
Primary practice location
5 Leighton CT
Melville, NY 11747-3910
Mailing address
5 Leighton Court
Melville, NY 11747
Phone (631) 495-7254
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090317000378 | NY | Practitioner - Clinical Psychologist | 5799842811 | Practice locations: North Bellmore, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5724 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233705600000",
"number": "1912145517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 LEIGHTON COURT",
"city": "MELVILLE",
"state": "NY",
"postal_code": "11747",
"telephone_number": "631-495-7254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 LEIGHTON CT",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117473910",
"telephone_number": "631-495-7254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "PHYLLIS",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-02-04",
"last_updated": "2009-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "5724",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2009; 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.