Active NPI
Joseph J Colletti, PHD
- Clinical Psychologist
- Madison, WI
National Provider Identifier
1164423000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2092057
- Practice address
- 702 N Blackhawk Ave
Suite 100
Madison, WI 53705-3357 - Phone
- (608) 663-5449
- Fax
- (608) 663-5928
- NPI assigned
- Aug 2, 2005
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2092057 | WI | Primary |
Addresses
Primary practice location
702 N Blackhawk Ave
Suite 100
Madison, WI 53705-3357
Mailing address
702 N Blackhawk Ave
Suite 100
Madison, WI 53705-3357
Phone (608) 663-5449
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2092057 | WI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398038400000",
"number": "1164423000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 N BLACKHAWK AVE",
"address_2": "SUITE 100",
"city": "MADISON",
"state": "WI",
"postal_code": "537053357",
"telephone_number": "608-663-5449",
"fax_number": "608-663-5928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "702 N BLACKHAWK AVE",
"address_2": "SUITE 100",
"city": "MADISON",
"state": "WI",
"postal_code": "537053357",
"telephone_number": "608-663-5449",
"fax_number": "608-663-5928"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLETTI",
"first_name": "JOSEPH",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-02",
"last_updated": "2014-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "2092057",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.