Active NPI
Donna R Vickery, M.D.
- Psychologist
- Summit, NJ
National Provider Identifier
1255373841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 25MA05262400
- Practice address
- 19 Prospect St
Summit, NJ 07901-2530 - Phone
- (330) 758-4515
- Fax
- (330) 758-5121
- NPI assigned
- Jun 11, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 25MA05262400 | NJ | Primary |
Addresses
Primary practice location
19 Prospect St
Summit, NJ 07901-2530
Mailing address
19 Prospect St
Summit, NJ 07901-2530
Phone (330) 758-4515
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA05262400 | NJ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238457600000",
"number": "1255373841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 PROSPECT ST",
"city": "SUMMIT",
"state": "NJ",
"postal_code": "079012530",
"telephone_number": "330-758-4515",
"fax_number": "330-758-5121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 PROSPECT ST",
"city": "SUMMIT",
"state": "NJ",
"postal_code": "079012530",
"telephone_number": "330-758-4515",
"fax_number": "330-758-5121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VICKERY",
"first_name": "DONNA",
"middle_name": "R",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-11",
"last_updated": "2009-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NJ",
"license": "25MA05262400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Summit, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.