NPIMap

Organization Active NPI

Dr Nahal C Kaivan Psychological Services PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Larchmont, NY
National Provider Identifier
1952147449
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
DR NAHAL C KAIVAN PSYCHOLOGICAL SERVICES PLLC
Practice address
2001 Palmer Ave Ste 205
Larchmont, NY 10538-2420
Phone
(917) 979-8736
Fax
(914) 292-9166
NPI assigned
Jul 3, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Authorized official

Name
Nahal Kaivan, PH.D.NPI 1194203901
Title
Owner/Clinic Director
Phone
(858) 735-5425

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

2001 Palmer Ave Ste 205
Larchmont, NY 10538-2420

Mailing address

2001 Palmer Ave Ste 205
Larchmont, NY 10538-2420
Phone (917) 979-8736

Other names 1

  • Ellie Mental Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241108000119 NY Part B Supplier - Clinic/Group Practice 0345774709 Receives reassigned benefits from 7 practitioners
Practice locations: Larchmont, NY

National Provider Directory

National Provider Directory

Locations

2001 Palmer Ave
Ste 205
Larchmont, NY 10538
Phone (917) 575-9713

2001 Palmer Ave
#208
Larchmont, NY 10538

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1719964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1952147449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 PALMER AVE STE 205",
            "city": "LARCHMONT",
            "state": "NY",
            "postal_code": "105382420",
            "telephone_number": "917-979-8736",
            "fax_number": "914-292-9166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 PALMER AVE STE 205",
            "city": "LARCHMONT",
            "state": "NY",
            "postal_code": "105382420",
            "telephone_number": "917-979-8736",
            "fax_number": "914-292-9166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR NAHAL C KAIVAN PSYCHOLOGICAL SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-03",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-26",
        "status": "A",
        "authorized_official_last_name": "KAIVAN",
        "authorized_official_first_name": "NAHAL",
        "authorized_official_title_or_position": "OWNER/CLINIC DIRECTOR",
        "authorized_official_telephone_number": "858-735-5425",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellie Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ellie Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Larchmont, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.