Domenick Tirabassi IV, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5089-57 Issued in WI

Practice address

9205 W Center St Ste 203
Milwaukee, WI 53222-4548

Phone

(414) 377-4787

Fax

(866) 643-0083

NPI assigned

Jul 24, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Agnesian Healthcare, Inc

  • General Acute Care Hospital
  • Fond Du Lac, WI
  • NPI 1346228541
  Medicare reassignment NPD
• Tosa Psychological Services LLC

  • Clinical Psychologist
  • Milwaukee, WI
  • NPI 1164256038
  NPD Authorized official
• Agnesian Healthcare Inc

  • Community/Retail Pharmacy
  • Waupun, WI
  • NPI 1366417917
  NPD
• Agnesian Healthcare Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fond Du Lac, WI
  • NPI 1841320884
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787270400000",
    "number": "1023662459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9205 W CENTER ST STE 203",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532224548",
            "telephone_number": "414-377-4787",
            "fax_number": "866-643-0083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9205 W CENTER ST STE 203",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532224548",
            "telephone_number": "414-377-4787",
            "fax_number": "866-643-0083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIRABASSI",
        "first_name": "DOMENICK",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-24",
        "last_updated": "2026-08-21",
        "certification_date": "2026-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "5089-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shana Marie Tims
• Yi-Lee Ting, MS
• Tiny Feet & Heart Beats LLC
• Tiny Miracles Doula Services Inc
• Tiny Toes Prenatal Care LLC
• Terra Michelle Tirnanic, APNP
• Kathryn E Tisdall, PHARMD
• Nesime Setge Tiskaoglu, MD
• William B Tisol, MD
• Mohammad Titi, MD

• Clinical Psychologist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.