Active NPI
Jaclyn E Mooney, PSY.D.
- Psychologist
- Wantagh, NY
National Provider Identifier
1972057479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 021690
- Practice address
- 2850 N Jerusalem Rd
Wantagh, NY 11793-1125 - Phone
- (516) 396-2697
- NPI assigned
- Aug 12, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 021690 | NY | Primary |
Addresses
Primary practice location
2850 N Jerusalem Rd
Wantagh, NY 11793-1125
Mailing address
214 Little Plains Rd
Huntington, NY 11743-4847
Phone (516) 849-0129
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021690 | NY | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470960000000",
"number": "1972057479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "214 LITTLE PLAINS RD",
"city": "HUNTINGTON",
"state": "NY",
"postal_code": "117434847",
"telephone_number": "516-849-0129"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2850 N JERUSALEM RD",
"city": "WANTAGH",
"state": "NY",
"postal_code": "117931125",
"telephone_number": "516-396-2697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOONEY",
"first_name": "JACLYN",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-08-12",
"last_updated": "2016-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "021690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wantagh, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.