Active NPI
Dominic J Liantonio, LMHC
- Addiction (Substance Use Disorder) Counselor
- Southbridge, MA
National Provider Identifier
1073662367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 5151
- Practice address
- 29 Pine St
Southbridge, MA 01550-1823 - Phone
- (508) 764-9167
- Fax
- (508) 764-2462
- NPI assigned
- Jan 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 5151 | MA | Primary |
Addresses
Primary practice location
29 Pine St
Southbridge, MA 01550-1823
Mailing address
29 Pine Street
Southbridge, MA 01550
Phone (508) 765-9167
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1200704 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5151 | MA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227139200000",
"number": "1073662367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 PINE STREET",
"city": "SOUTHBRIDGE",
"state": "MA",
"postal_code": "01550",
"telephone_number": "508-765-9167",
"fax_number": "508-764-2462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29 PINE ST",
"city": "SOUTHBRIDGE",
"state": "MA",
"postal_code": "015501823",
"telephone_number": "508-764-9167",
"fax_number": "508-764-2462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIANTONIO",
"first_name": "DOMINIC",
"middle_name": "J",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2008-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MA",
"license": "5151",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1200704",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southbridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.