Active NPI
Michael J Cardillo, PH.D.
- Clinical Psychologist
- Port Jefferson, NY
National Provider Identifier
1184788077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6906
- Practice address
- 41 N Country Rd
Office #1
Port Jefferson, NY 11777-2160 - Phone
- (631) 473-0020
- NPI assigned
- Dec 22, 2006
- 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 | 6906 | NY | Primary |
Addresses
Primary practice location
41 N Country Rd
Office #1
Port Jefferson, NY 11777-2160
Mailing address
41 N Country Rd
Office #1
Port Jefferson, NY 11777-2160
Phone (631) 473-0020
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0010451 | Other | NY | GHI ID |
| 147518 | Other | NY | VALUE OPTIONS |
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 |
|---|---|---|---|
| 6906 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1184788077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41 N COUNTRY RD",
"address_2": "OFFICE #1",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117772160",
"telephone_number": "631-473-0020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41 N COUNTRY RD",
"address_2": "OFFICE #1",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117772160",
"telephone_number": "631-473-0020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARDILLO",
"first_name": "MICHAEL",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "6906",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI ID",
"identifier": "0010451",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "147518",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.