PHYLLIS BROEGE (NPI# 1669460762) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669460762 |
| Entity Type | Individual |
| Full Name | PHYLLIS BROEGE |
| Credential | PHD |
| Practice Address |
2 Country Club Rd Queensbury NY 12804-1702 |
| Mailing Address |
100 Park St Glens Falls Hospital Glens Falls NY 12801-4413 |
| Practice Telephone | 5189262000 |
| Practice Fax Number | 5189262020 |
| Mailing Telephone | 5189267200 |
| Mailing Fax Number | 5189267036 |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2019-11-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 013412 | NY | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 02070735 | 05 | |
| NY | RR MEDICARE | 680014530 | 01 |
| Street Address |
2 COUNTRY CLUB RD |
| City | QUEENSBURY |
| State | NY |
| Zip Code | 12804-1702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386251288 | Sarah Broughton | Audiologist | 2 Country Club Rd, Queensbury, NY 12804-1702 | 2020-09-25 |
| 1306452677 | Kaitlyn Ann Hansen | Physical Therapist | 2 Country Club Rd, Queensbury, NY 12804-1702 | 2020-09-21 |
| 1215561303 | Andrea Nicole Fauler | Occupational Therapist | 2 Country Club Rd, Queensbury, NY 12804-1702 | 2020-02-27 |
| 1902373384 | David Bruce Lieberman | Psychologist | 2 Country Club Rd, Queensbury, NY 12804-1702 | 2018-10-24 |
| 1316428360 | Ashley Elizabeth Bucci | Audiologist | 2 Country Club Rd, Queensbury, NY 12804-1702 | 2018-08-28 |
| 1487146445 | Rachel Deluca | Audiologist | 2 Country Club Rd, Queensbury, NY 12804 | 2018-06-05 |
| 1760996359 | Liesl Hall | Occupational Therapist | 2 Country Club Rd, Queensbury, NY 12804-1702 | 2017-11-20 |
| 1215452396 | Sandra Chamoun | Occupational Therapist | 2 Country Club Rd, Queensbury, NY 12804-1702 | 2017-08-09 |
| 1619421930 | Catherine Houshower | Physical Therapist | 2 Country Club Rd, Queensbury, NY 12804-1702 | 2016-08-04 |
| 1053773457 | Brittany Strain | Occupational Therapist | 2 Country Club Rd, Queensbury, NY 12804-1702 | 2016-03-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265060958 | Dani Grace Filicetti | Student in an Organized Health Care Education/Training Program | 423 Bay Rd, Queensbury, NY 12804 | 2020-03-30 |
| 1861977704 | Leslie Ann Warren | Counselor | 24 Cedarwood Drive, Queensbury, NY 12804 | 2018-09-26 |
| 1598294910 | Molly Gillespie | Speech-Language Pathologist | 9 Sylvan Ave, Queensbury, NY 12804 | 2017-06-08 |
| 1306207196 | Dorothy Duggan | Registered Nurse | 128 Aviation Road, Queensbury, NY 12804 | 2016-03-08 |
| 1568731115 | Kph Healthcare Services, Inc. | Pharmacy | 161 Carey Road, Queensbury, NY 12804 | 2011-12-27 |
| 1164701017 | Wal-mart Stores East Lp | Technician/Technologist | 24 Quaker Ridge Blvd, Queensbury, NY 12804 | 2011-08-10 |
| 1821275256 | Koock E Jung Md PC | Social Worker | 597 Bay Road, Queensbury, NY 12804 | 2008-01-29 |
| 1477765246 | Warren Washington Counties Chapter Nysarc Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 375 Bay Road, Suite 200, Queensbury, NY 12804 | 2007-05-04 |
| 1336299742 | Town of Queensbury Union Free School District 2 | Local Education Agency (LEA) | 429 Aviation Road, Queensbury, NY 12804 | 2007-01-11 |
| 1578658761 | Richard Jay Reisman | Dentist | 8 Baywood Drive, Glens Falls, NY 12804 | 2006-10-04 |
| Find all providers in zip 12804 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134328305 | Gisela Davila | Psychologist | 63 Tuthill Rd, Queensbury, NY 12804-8457 | 2007-07-17 |
| 1477619252 | Michael P Homenick | Psychologist | 551 Bay Rd, Queensbury, NY 12804-1441 | 2006-12-28 |
| 1831390855 | Samantha Gwynne Caruso | Psychologist | 161 Carey Rd, Queensbury, NY 12804-7821 | 2007-05-29 |
| 1831246792 | Psychological Associates of Northeastern New York PC | Psychologist | 551 Bay Rd, Queensbury, NY 12804-1280 | 2007-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700487774 | Rebecca Kason | Psychologist | 38 Broome St Apt 2b, Brooklyn, NY 11222-5515 | 2020-11-05 |
| 1952900177 | Sarah Slotkin | Psychologist | 997 Altamont Blvd, Altamont, NY 12009-6313 | 2020-10-19 |
| 1265031488 | John Raymond Keefe | Psychologist | 205 E 95th St Apt 6c, New York, NY 10128-0233 | 2020-10-19 |
| 1447859830 | Casey Dowdell | Psychologist | 2201 Hempstead Tpke # 10, East Meadow, NY 11554-1859 | 2020-10-18 |
| 1578161063 | Amanda Robyn Schwartz | Psychologist | 11 Appleby Dr, Bedford, NY 10506-1340 | 2020-10-15 |
| 1912505967 | Tracy Lynn Clouthier | Psychologist | 203 Lillian Ave Apt 3, Syracuse, NY 13206-2155 | 2020-10-13 |
| 1477150035 | Laura Joy Kaplan | Psychologist | 1619 3rd Ave Apt 29h, New York, NY 10128-3942 | 2020-10-07 |
| 1639786833 | Benjamin Malkin | Psychologist | 663 Golf Dr, Valley Stream, NY 11581-3547 | 2020-09-30 |
| 1043827678 | Paul Lichtenberg | Psychologist | 236 Tow Path Rd, Accord, NY 12404-5516 | 2020-09-28 |
| 1073129169 | Alyssa Van Der Merwe | Psychologist | 500 Mamaroneck Ave Ste 320, Harrison, NY 10528-1600 | 2020-09-23 |
| Find all providers with the same taxonomy | ||||
| City | QUEENSBURY |
| Zip Code | 12804 |
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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.