Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Michael Leonard Nissenbaum, PHD

Individual provider Cognitive & Behavioral Psychologist · NPI 1174546725

Dr. Michael Leonard Nissenbaum, PHD is a Clinical Psychologist in Centereach, New York. Qualified in 1988, 38 years ago. Practices as a sole proprietor, accepts Medicare assignment and offers telehealth. Licensed in New York.

Years since qualifying
38
Licensed in
NY
In the registry since
2006
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

See every abbreviation used in this directory →

Practice location Address checks out

2100 Middle Country Rd Ste 28W
Centereach, NY 11720-3577
Phone: (631) 737-9500
Fax: (631) 737-9512
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Cognitive & Behavioral Psychologist (primary) Taxonomy 103TB0200X · Licence 010232 (NY)

Record details

NPI number1174546725
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorYes
NPI enumeratedJuly 25, 2006
Last updated in NPPESJuly 8, 2007

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 1988 (38 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Centereach