PROFESSIONAL PSYCHIATRIC SERVICES P.C. (NPI# 1417902065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417902065 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL PSYCHIATRIC SERVICES P.C. |
| Practice Address |
6722 Erie Rd Derby NY 14047-9670 |
| Mailing Address |
6722 Erie Rd Po Box 803 Derby NY 14047-9670 |
| Practice Telephone | 7169472097 |
| Practice Fax Number | 7169475909 |
| Mailing Telephone | 7169472097 |
| Mailing Fax Number | 7169475909 |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2012-10-16 |
| Authorized Official Name | DR. ANTHONY ANGELO RACANIELLO (PRESIDENT) |
| Authorized Official Telephone | 7169472097 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0805X |
Psychiatry & Neurology Specialization: Geriatric Psychiatry |
188585 | NY | Allopathic & Osteopathic Physicians |
| N | 2084P0802X |
Psychiatry & Neurology Specialization: Addiction Psychiatry |
188585 | NY | Allopathic & Osteopathic Physicians |
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
188585 | NY | Allopathic & Osteopathic Physicians |
| Street Address |
6722 ERIE RD |
| City | DERBY |
| State | NY |
| Zip Code | 14047-9670 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326683343 | Jordan Alston | Counselor | 6722 Erie Rd, Derby, NY 14047-9670 | 2019-11-13 |
| 1750923371 | Joanna Marie Palma | Counselor | 6722 Erie Rd, Derby, NY 14047-9670 | 2019-10-15 |
| 1891206231 | Megan Brautlacht | Counselor | 6722 Erie Rd, Derby, NY 14047-9670 | 2017-10-12 |
| 1417487448 | Mary Beth Mccormick | Counselor | 6722 Erie Rd, Derby, NY 14047-9670 | 2017-06-13 |
| 1760922421 | Mary Katherine Nolan-eaton | Counselor | 6722 Erie Rd, Derby, NY 14047-9670 | 2017-02-28 |
| 1902219645 | Natalie Bucholtz | Social Worker | 6722 Erie Rd, Derby, NY 14047-9670 | 2014-06-10 |
| 1568753580 | Cynthia S Miller | Nurse Practitioner | 6722 Erie Rd, Derby, NY 14047-9670 | 2011-04-25 |
| 1376784199 | Valerie A Nowak | Counselor | 6722 Erie Rd, Derby, NY 14047-9670 | 2009-03-09 |
| 1275730004 | Jennifer Burt | Social Worker | 6722 Erie Rd, Derby, NY 14047-9670 | 2007-06-27 |
| 1497828461 | Harmonia Collaborative Care Inc | Clinic/Center | 6722 Erie Rd, Derby, NY 14047 | 2006-11-16 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225654494 | Brooks - Tlc Hospital System, Inc. | Rehabilitation, Substance Use Disorder Unit | 7020 Erie Road, Derby, NY 14047 | 2020-06-23 |
| 1114219607 | Frederick Eckles Jr. | Licensed Practical Nurse | 6816 Erie Road, Derby, NY 14047 | 2011-05-03 |
| 1477887560 | Henna M Patel | Family Medicine | 7060 Erie Rd Suite 100, Derby, NY 14047 | 2009-09-23 |
| 1134300668 | Lisa M Bogner | Pharmacist | 3590 Union Rd, Cheektowaga, NY 14047 | 2007-11-27 |
| 1760546378 | James G Stengel | Internal Medicine | 1667 South Creek Rd, Derby, NY 14047 | 2006-12-20 |
| 1093888463 | Paul J Caro Md | Family Medicine | 7008 Erie Rd Rte 5, Suite A, Derby, NY 14047 | 2006-11-15 |
| 1417037755 | John M Mulawka IIi | Pediatrics | 6763 Erie Road Rt 5, Derby, NY 14047 | 2006-10-17 |
| 1720367782 | Michelle M Sirolli | Licensed Practical Nurse | 6816 Erie Road, Derby, NY 14047 | 2011-08-09 |
| 1770862682 | Janet E Pajak | Licensed Practical Nurse | 6816 Erie Road, Derby, NY 14047 | 2011-08-09 |
| 1316978869 | Robert Jude Joba | Optometrist | 6929 Erie Rd, Derby, NY 14047 | 2006-07-05 |
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| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083682900 | Benjamin Joshua Zigun | Psychiatry & Neurology | 248 Seymour Ave, Griffin Hospital, Derby, CT 06418-1332 | 2006-03-08 |
| 1427058478 | Mihaela Boran | Psychiatry & Neurology | 130 Division St, Derby, CT 06418-1326 | 2005-07-29 |
| 1114199445 | Raina Sotsky | Psychiatry & Neurology | 30 Elizabeth St, Derby, CT 06418-1802 | 2008-03-26 |
| 1386679926 | Gordon Kuster | Psychiatry & Neurology | 130 Division St, Derby, CT 06418-1326 | 2006-07-12 |
| 1497701478 | Anthony Angelo Racaniello | Psychiatry & Neurology | 6722 Erie Rd, Derby, NY 14047-9670 | 2006-05-25 |
| 1154374544 | Kenneth J Garcia | Psychiatry & Neurology | 130 Division St, Derby, CT 06418-1326 | 2006-05-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447850276 | Nyc Psychiatric Associates | Psychiatry & Neurology | 385 5th Ave Rm 1106, New York, NY 10016-3340 | 2020-10-30 |
| 1063010718 | Integrative Medicine Psychiatry P.C. | Psychiatry & Neurology | 200 Prospect Park W Ste 1r, Brooklyn, NY 11215-5717 | 2020-10-14 |
| 1760097927 | Vital Balance Osteopathy, Pllc | Psychiatry & Neurology | 10 Bond Street, Ste 1, #290, Great Neck, NY 11021 | 2020-09-14 |
| 1356955934 | Hillside Tms Pllc | Psychiatry & Neurology | 1575 Hillside Ave Ste 208, New Hyde Park, NY 11040-2501 | 2020-09-01 |
| 1730706169 | Scott Dibartolo | Psychiatry & Neurology | 426 W 45th St Apt 5fe, New York, NY 10036-9066 | 2020-07-01 |
| 1669096699 | Preserving Healthy Minds, Nurse Practitioner of Psychiatry Pllc | Psychiatry & Neurology | 493 Shoddy Hollow Rd, Middletown, NY 10940-7509 | 2020-06-05 |
| 1104449701 | Clear Minds Nyc, LLC | Psychiatry & Neurology | 210 E 121st St Apt 2m, New York, NY 10035-3053 | 2020-05-19 |
| 1215556774 | Allexian, LLC | Psychiatry & Neurology | 418 E 71st St Ph Fl, New York, NY 10021-4894 | 2020-04-14 |
| 1427682350 | Brian Francis Esposito | Psychiatry & Neurology | 435 E 70th St Apt 27h, New York, NY 10021-5349 | 2020-02-29 |
| 1972135416 | Cnypsychiatry | Psychiatry & Neurology | 1/2 Orange St Ste 2, Marcellus, NY 13108-1216 | 2020-02-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.