NPIMap

Organization Active NPI

Boomer Psychological Services PC

  • Clinical Psychologist
  • New York, NY
National Provider Identifier
1992132963
Registry record updated Oct 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
011975 Issued in NY
Legal business name
BOOMER PSYCHOLOGICAL SERVICES PC
Practice address
201 E 77TH St Apt 16E
New York, NY 10075-2085
Phone
(212) 861-0740
NPI assigned
Oct 4, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2013

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

Authorized official

Name
Bonnie Kellen, PHDNPI 1265668081
Title
President
Phone
(212) 861-0740

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 011975 NY Primary

Addresses

Primary practice location

201 E 77TH St Apt 16E
New York, NY 10075-2085

Mailing address

201 E 77TH St Apt 16E
New York, NY 10075-2085
Phone (212) 861-0740

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1380844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380844800000",
    "number": "1992132963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E 77TH ST APT 16E",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100752085",
            "telephone_number": "212-861-0740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E 77TH ST APT 16E",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100752085",
            "telephone_number": "212-861-0740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOOMER PSYCHOLOGICAL SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-04",
        "last_updated": "2013-10-04",
        "status": "A",
        "authorized_official_last_name": "KELLEN",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-861-0740",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "011975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.