Active NPI
William M Bennison, PH.D.
- Clinical Psychologist
- Port Jefferson, NY
National Provider Identifier
1962489153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 006877
- Practice address
- 1 High Path
Hope House
Port Jefferson, NY 11777-1276 - Phone
- (631) 928-9112
- NPI assigned
- Dec 28, 2005
- Sex
- Male
- 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 | 006877 | NY | Primary |
Addresses
Primary practice location
1 High Path
Hope House
Port Jefferson, NY 11777-1276
Mailing address
PO Box 452
Port Jefferson, NY 11777-0452
Phone (631) 928-9112
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00696231 | Medicaid | NY |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271635200000",
"number": "1962489153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 452",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117770452",
"telephone_number": "631-928-9112",
"fax_number": "631-928-1960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 HIGH PATH",
"address_2": "HOPE HOUSE",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771276",
"telephone_number": "631-928-9112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNISON",
"first_name": "WILLIAM",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-28",
"last_updated": "2010-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "006877",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00696231",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.