Susannah Kondrath, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS01867 Issued in RI

Practice address

830 Chalkstone Ave
Providence, RI 02908-4734

Phone

(401) 273-7100

NPI assigned

Jun 18, 2020

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

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Health Psych Maine LLCGroup PAC ID 9739513219, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Health Psych Maine LLC

  • Health Service Psychologist
  • Waterville, ME
  • NPI 1881231553
  Medicare reassignment Care Compare group NPD
• Health Psych Maine, LLC

  • Health Service Psychologist
  • Waterville, ME
  • NPI 1134146798
  NPD

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

{
    "created_epoch": "1592438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592438400000",
    "number": "1952927675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 EAGLE ST UNIT 222",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029085642",
            "telephone_number": "781-710-1468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 CHALKSTONE AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084734",
            "telephone_number": "401-273-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONDRATH",
        "first_name": "SUSANNAH",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-18",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "RI",
            "license": "PS01867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Kolesar Fabris, D.C.
• Meghana Koleti, MD
• Michele Kolodziejczak, RN
• Sreeya Sai Komaravolu, MD
• Mallikarjun Reddy Komsani, MD, MBBS
• Robert James Koness, M.D.
• David Ira Konicov, DDS
• Rosemary C Kopec, CRNA
• Andrew Stephen Kopecky, MD
• Kerryann Elizabeth Koper

• Clinical Psychologist in Providence, RI
• Providers in Providence, RI by specialty
• Clinical Psychologist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.