Kristine Anne Komada, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

9182 Issued in NY

Practice address

Bethany House II
199-19 113TH Avenue
St Albans, NY 11412

Phone

(917) 685-7145

NPI assigned

Jun 9, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623196800000",
    "number": "1922675834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4809 216TH ST",
            "city": "BAYSIDE HILLS",
            "state": "NY",
            "postal_code": "113641334",
            "telephone_number": "347-453-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BETHANY HOUSE II",
            "address_2": "199-19 113TH AVENUE",
            "city": "ST ALBANS",
            "state": "NY",
            "postal_code": "11412",
            "telephone_number": "917-685-7145"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Bethany House I",
            "address_2": "164 Suydam Street",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "11221",
            "country_code": "US",
            "telephone_number": "917-685-7145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOMADA",
        "first_name": "KRISTINE",
        "middle_name": "ANNE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-09",
        "last_updated": "2021-06-09",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "9182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kkomada@sco.org",
            "affiliation": "N",
            "address_1": "Bethany House I",
            "address_2": "164 Suydam Street",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "11221",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kkomada@sco.org",
            "affiliation": "N",
            "address_1": "Bethany House I",
            "address_2": "164 Suydam Street",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "11221",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kkomada@sco.org",
            "affiliation": "N",
            "address_1": "Bethany House I",
            "address_2": "164 Suydam Street",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "11221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shira E Kirschner, MA, CCC-SLP
• Denise Kirton, RN
• Pamela Knight - Edwards
• Meika Knight
• Emson Kokura, PT
• Mary E Koyl, LCSW
• Yetunde D Kupoluyi
• Tiffany La Croix, LCSW
• Josephine P Lacson
• Paulette Noeline Laird

• Psychologist in St Albans, NY
• Providers in St Albans, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; 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.