npidexNPI registry + Medicare data

ETTALEE PASS, PH.D.

Clinical Psychologist · SMITHTOWN, NY

Individual Active Opted out of Medicare NPI 1275576241

Taxonomy & licensure

SpecialtyCodePrimaryLicenseState
Clinical Psychologist103TC0700X✓011597NY

Medicare eligibility

Opted out of Medicare (Clinical Psychologist), effective 2020-03-01 through 2028-03-01.

Other Clinical Psychologist providers in New York

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Source: NPPES (public domain) and CMS Medicare Physician & Other Practitioners data. Not affiliated with CMS, NPPES, or any government agency.