SUSANNA WILDE (NPI# 1568570901) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568570901 |
| Entity Type | Individual |
| Full Name | SUSANNA WILDE |
| Credential | PHD |
| Practice Address |
2215 Burdett Ave Behavioral Health Dept Troy NY 12180 |
| Mailing Address |
Po Box 14890 Albany NY 12212-4890 |
| Practice Telephone | 5182713300 |
| Mailing Telephone | 5185255634 |
| Mailing Fax Number | 5186494094 |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2018-09-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 013092 | NY | Behavioral Health & Social Service Providers |
| Street Address |
2215 BURDETT AVE BEHAVIORAL HEALTH DEPT |
| City | TROY |
| State | NY |
| Zip Code | 12180 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770583619 | Kakulavaram Venkat Reddy | Radiology | 2215 Burdett Ave, Samaritian Hospital Cancer Care Center, Troy, NY 12180-2466 | 2005-07-21 |
| 1356959316 | Daniel Grant Pecan | Nurse Practitioner | 2215 Burdett Ave, Troy, NY 12180-2475 | 2020-07-16 |
| 1902424443 | Amanda Marie Benacquisto | Registered Nurse | 2215 Burdett Ave, Troy, NY 12180-2466 | 2020-07-10 |
| 1013540855 | Renee C Sanderson | Physical Therapist | 2215 Burdett Ave, Troy, NY 12180-2466 | 2020-02-20 |
| 1013540194 | Jessica S Zahner | Occupational Therapist | 2215 Burdett Ave, Troy, NY 12180-2466 | 2020-02-18 |
| 1932731718 | Catherine Berrian Smith | Physical Therapist | 2215 Burdett Ave, Troy, NY 12180-2466 | 2020-02-10 |
| 1053941609 | Paula Jean Burnor | Physical Therapist | 2215 Burdett Ave, Troy, NY 12180-2466 | 2020-01-23 |
| 1811527724 | Jennifer Musone Singer | Pharmacist | 2215 Burdett Ave, Troy, NY 12180-2466 | 2020-01-20 |
| 1700423951 | Rose Anne Mason | Registered Nurse | 2215 Burdett Ave, Troy, NY 12180-2466 | 2019-12-06 |
| 1164064275 | Joan Marie Killeen | Registered Nurse | 2215 Burdett Ave, Troy, NY 12180-2466 | 2019-10-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528616232 | Gwendolyn Eve Guarino | Massage Therapist | Lux, 207 River St, Troy, NY 12180 | 2019-08-27 |
| 1568020857 | Shelby Mara Quintal | Counselor | 7 Collins Ave, Troy, NY 12180 | 2019-05-31 |
| 1881179646 | St. Peter's Health Partners Medical Associates, P.C. | Family Medicine | 2109 15th Street, Troy, NY 12180 | 2018-09-27 |
| 1104354315 | Karen Lynm Vincent | Licensed Practical Nurse | 830 Hoosick Rd Apt 1, Troy, NY 12180 | 2017-06-01 |
| 1740728013 | Upstate Physician Services, PC | Specialist | 2001 5th Avenue, Suite 110, Troy, NY 12180 | 2017-02-07 |
| 1205373263 | Tsu Han Poh | Pharmacist | 204 Washington Street, Apt C1, Troy, NY 12180 | 2017-01-27 |
| 1053760546 | Linda Pierre | Religious Nonmedical Nursing Personnel | 1680 Tibbits Ave, Troy, NY 12180 | 2016-06-06 |
| 1518312925 | Matthew Pittelli | Student in an Organized Health Care Education/Training Program | 83 Lockrow Rd, Troy, NY 12180 | 2016-05-04 |
| 1780045765 | Tara Michelle Miller | Hearing Instrument Specialist | 2000 6th Avenue, Troy Towers, Bldg. B, 1st Floor, Troy, NY 12180 | 2016-03-17 |
| 1326410937 | Seton Health System, Inc. | Physician Assistant | 1401 Massachusetts Avenue, Troy Internal Medicine, Troy, NY 12180 | 2015-10-22 |
| Find all providers in zip 12180 | ||||
| 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 |
|---|---|---|---|---|
| 1568943181 | Kristen Ghersi Hurrell | Psychologist | 3725 Rochester Rd, Troy, MI 48083-5244 | 2018-08-22 |
| 1225578214 | Casey Michelle Bazarewski | Psychologist | 5115 Babbit Dr, Troy, MI 48085-3448 | 2017-02-24 |
| 1902268402 | Michael Pignatiello | Psychologist | 1314 Windy Hill Ct, Troy, OH 45373-4572 | 2016-03-23 |
| 1932442829 | Jasmin Patel | Psychologist | 416 Evaline Dr, Troy, MI 48085-5509 | 2013-03-29 |
| 1851690721 | Melissa Kandah | Psychologist | 2221 Livernois Rd Ste 101, Troy, MI 48083-1603 | 2011-03-17 |
| 1205134525 | Michigan Behavioral Medicine | Psychologist | 625 E Big Beaver Road, Suite 101, Troy, MI 48083 | 2011-03-10 |
| 1710282611 | Marcie Wagner | Psychologist | 4780 Orchard Ridge Dr, Troy, MI 48098-4121 | 2011-01-24 |
| 1093832818 | James Wargel | Psychologist | 200 East Big Beaver Rd, Troy, MI 48083-1208 | 2007-03-25 |
| 1427197409 | James Clifford Kors | Psychologist | 2075 West Big Beaver, Suite 520, Troy, MI 48084 | 2007-02-06 |
| 1801949391 | John Thomas Lynch IIi | Psychologist | 3336 Essex Dr, Troy, MI 48084-2705 | 2007-01-19 |
| Find all providers in TROY | ||||
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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.