David Peradotto, PHD

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

6301008098 Issued in MI

Practice address

43450 W 10 Mile Rd
Novi, MI 48375-3172

Phone

(248) 344-7420

Fax

(248) 344-7423

NPI assigned

Jun 30, 2006

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

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Northbrook Psychological Clinic PLC

  • Psychologist
  • Novi, MI
  • NPI 1841279288
  NPD (past)
• Bobbi Ebsen Psychotherapy LLC

  • Clinical Social Worker
  • Albuquerque, NM
  • NPI 1689012379
  NPD (past)

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219276800000",
    "number": "1043249469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43450 W 10 MILE RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483753172",
            "telephone_number": "248-344-7420",
            "fax_number": "248-344-7423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43450 W 10 MILE RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483753172",
            "telephone_number": "248-344-7420",
            "fax_number": "248-344-7423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERADOTTO",
        "first_name": "DAVID",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2008-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MI",
            "license": "6301008098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC PIN",
            "identifier": "680F333060",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPC TAX ID",
            "identifier": "300040030",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VO",
            "identifier": "273178",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC PIN",
            "identifier": "680F321030",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN PIN",
            "identifier": "273178",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mackenzie Penrose
• Darren Penson
• Abigail Jane Peoples
• Vaganaalelai Esther Pepa-Lynch
• Alexander Awuakye Peprah, RPH
• Toni Perdue
• Ariel Perez-Smith
• Ana Gabriela Perez
• Carolyn Perez
• Claudia Perez

• Clinical Child & Adolescent Psychologist in Novi, MI
• Providers in Novi, MI by specialty
• Clinical Child & Adolescent Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.