NPIMap

Organization Active NPI

Psychological Services of Charlotte

  • Psychologist
  • Charlotte, NC
National Provider Identifier
1295768943
Registry record updated May 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2846 Issued in NC
Legal business name
PSYCHOLOGICAL SERVICES OF CHARLOTTE
Practice address
1923 J N Pease PL
Suite 204
Charlotte, NC 28262-4513
Phone
(704) 503-3535
Fax
(704) 593-5555
NPI assigned
Jul 8, 2006
Last updated
May 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Brian Ronald Monteleone, PH. D.NPI 1487695052
Title
President
Phone
(704) 503-3535

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Professional Counselor 101YP2500X 3328NCLPC NC
Professional Counselor 101YP2500X 12226 NC
Psychologist 103T00000X 3953 NC
Psychologist 103T00000X 3660 NC
Psychologist 103T00000X 4444 NC
Psychologist 103T00000X 2846 NC Primary
Clinical Social Worker 1041C0700X C004544 NC

Addresses

Primary practice location

1923 J N Pease PL
Suite 204
Charlotte, NC 28262-4513

Mailing address

1923 J N Pease PL
Suite 204
Charlotte, NC 28262-4513
Phone (704) 503-3535

Other identifiers 2

IdentifierTypeStateIssuer
017TAOtherNCBCBS
7496772OtherNCAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060323000207 NC Part B Supplier - Clinic/Group Practice 8921014499 Receives reassigned benefits from 6 practitioners
Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory

Locations

1923 J N Pease Pl
Ste 204
Charlotte, NC 28262
Phone (704) 503-3535

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589500800000",
    "number": "1295768943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1923 J N PEASE PL",
            "address_2": "SUITE 204",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282624513",
            "telephone_number": "704-503-3535",
            "fax_number": "704-593-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1923 J N PEASE PL",
            "address_2": "SUITE 204",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282624513",
            "telephone_number": "704-503-3535",
            "fax_number": "704-593-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL SERVICES OF CHARLOTTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2020-05-15",
        "certification_date": "2020-05-15",
        "status": "A",
        "authorized_official_last_name": "MONTELEONE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "RONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-503-3535",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PH. D."
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "3328NCLPC",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "12226",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "3953",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "3660",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "4444",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "2846",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C004544",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "017TA",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7496772",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.