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NPI 1225624463ActiveIndividual· Psychologist· Bryan, TX
Psychologist with Montefiore Medical Center, practicing in Bryan, Texas. Enrolled in Medicare as practitioner - clinical psychologist. Lists Montefiore Medical Center as a hospital affiliation.
Overview
| NPI | 1225624463 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | Yes |
| NPI issued | Dec 11, 2020 |
| Last updated in NPPES | Dec 11, 2020 |
| Certified by provider | Dec 11, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist Primary | 103T00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Psychologist (NY) |
|---|
Education and affiliations
| Graduation year | 2023 |
|---|---|
| Medicare specialty | Clinical Psychologist |
Medical group
- Montefiore Medical CenterBronx, NY · 2,820 clinicians
Hospital affiliation
- Montefiore Medical CenterBronx, NY
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