Active NPI
Dominic Letizia, PSY.D
- Clinical Psychologist
- Indianapolis, IN
National Provider Identifier
1215347802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20042871A
- Practice address
- 350 E New York St Ste 240
Indianapolis, IN 46204-2134 - Phone
- (260) 433-6950
- NPI assigned
- May 5, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 87000548A | IN | |
| Clinical Psychologist | 103TC0700X | 20042871A | IN | Primary |
Addresses
Primary practice location
350 E New York St Ste 240
Indianapolis, IN 46204-2134
Mailing address
350 E New York St Ste 240
Indianapolis, IN 46204-2134
Phone (260) 433-6950
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 |
|---|---|---|---|
| 87000548A | IN | MD | Addiction (Substance Use Disorder) Counselor |
| 20042871A | IN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465171200000",
"number": "1215347802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 E NEW YORK ST STE 240",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462042134",
"telephone_number": "260-433-6950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 E NEW YORK ST STE 240",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462042134",
"telephone_number": "260-433-6950"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LETIZIA",
"first_name": "DOMINIC",
"credential": "PSY.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-05-05",
"last_updated": "2016-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IN",
"license": "87000548A",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20042871A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.