Jennifer Smith, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

015747-1 Issued in NY

Practice address

12904 Newport Ave
Rockaway Park, NY 11694-1617

Phone

(347) 523-5321

NPI assigned

Jan 7, 2014

Last updated

Dec 2, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jennifer Smith Psychologist PC

  • Clinical Psychologist
  • Rockaway Park, NY
  • NPI 1235650201
  Medicare reassignment NPD Authorized official
• Rockapulco Medical Assoc PC

  • Internal Medicine Physician
  • Rockaway Park, NY
  • NPI 1073698221
  NPD (past)

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

{
    "created_epoch": "1389052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1982026100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 POINT BREEZE AVE",
            "city": "BREEZY POINT",
            "state": "NY",
            "postal_code": "116971621",
            "telephone_number": "917-355-2031",
            "fax_number": "973-423-9580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12904 NEWPORT AVE",
            "city": "ROCKAWAY PARK",
            "state": "NY",
            "postal_code": "116941617",
            "telephone_number": "347-523-5321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-07",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "015747-1",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "SI1005289",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35SI00528900",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shibrah M. Jamil, MD, P.C.
• John Richard Shure, D.D.S.
• Dilranie Singh, M.S.,OTRL
• SJ Behavioral Services Inc
• Smile Masters LLC (Rockaway Beach Orthodontics)
• Kerry-Ann Keisha Smith, RDMS
• Thomas Gerard Smith Jr., PSYCHOANALYST
• Theresa Elizabeth Smyth-Nestor
• Solstice Idtf, Inc
• Solstice Medical Group PLLC

• Clinical Psychologist in Rockaway Park, NY
• Providers in Rockaway Park, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; 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.