Annamaria Pruscino, PHD
Individual provider Active NPI Psychologist · Hatawan, NJ
NPI 1154497089 · NPPES record last updated Oct 3, 2023
Key facts
- NPI
- 1154497089
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 35SI00325000 (NJ)
- Practice address
- 177 Main St
Hatawan, NJ 07747 - Phone
- (732) 765-8778
- Fax
- (732) 765-8768
- NPI assigned
- Nov 24, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1208 Route 34
Aberdeen, NJ 07747-1940
Phone (732) 765-8778
177 Main St
Matawan, NJ 07747-4107
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111206000101 | NJ | Practitioner - Clinical Psychologist | 9830364702 | Practice locations: Aberdeen, NJ |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SI03250 | NJ | MD | Clinical Psychologist |
| 0099121 | NY | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Azz Medical Associates PC | Past |
Accepting new patients | |
| Matawan Aberdeen Heart & Medical Center | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | SI03250 | NJ | |
| Clinical Psychologist | 103TC0700X | 0099121 | NY | |
| Psychologist | 103T00000X | 35SI00325000 | NJ | Yes |
Addresses
Primary practice location
177 Main St
Hatawan, NJ 07747
Mailing address
177 Main St
Hatawan, NJ 07747
Phone (732) 765-8778
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.