NPIMap

Organization Active NPI

Pine Bush Mental Health, LLP

  • Clinical Psychologist
  • Albany, NY
National Provider Identifier
1962572362
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
014323 Issued in NY
Legal business name
PINE BUSH MENTAL HEALTH, LLP
Practice address
1A Pine West PLZ
Albany, NY 12205-5556
Phone
(518) 862-1665
Fax
(518) 862-1668
NPI assigned
Nov 9, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Patricia Polanik Miller, PH.D.NPI 1831257740
Title
Licensed Psychologist
Phone
(518) 862-1665

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 014323 NY Primary

Addresses

Primary practice location

1A Pine West PLZ
Albany, NY 12205-5556

Mailing address

1A Pine West PLZ
Albany, NY 12205-5556
Phone (518) 862-1665

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070315000303 NY Part B Supplier - Clinic/Group Practice 0547363327 Receives reassigned benefits from 4 practitioners
Practice locations: Albany, NY

National Provider Directory

National Provider Directory

Locations

385 Watervliet Shaker Rd
Latham, NY 12110
Phone (518) 213-7526

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962572362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1A PINE WEST PLZ",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122055556",
            "telephone_number": "518-862-1665",
            "fax_number": "518-862-1668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1A PINE WEST PLZ",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122055556",
            "telephone_number": "518-862-1665",
            "fax_number": "518-862-1668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE BUSH MENTAL HEALTH, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "POLANIK",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "518-862-1665",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "014323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.