Active NPI
Vincent Joseph Adesso, PHD
- Clinical Psychologist
- Milwaukee, WI
National Provider Identifier
1316907694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 608057
- Practice address
- 5555 North Port Washington Rd
Ste 304
Milwaukee, WI 53217-4927 - Phone
- (414) 967-9552
- Fax
- (414) 967-9550
- NPI assigned
- Mar 23, 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 | 608057 | WI | Primary |
Addresses
Primary practice location
5555 North Port Washington Rd
Ste 304
Milwaukee, WI 53217-4927
Mailing address
5555 North Port Washington Rd
Ste 304
Milwaukee, WI 53217-4927
Phone (414) 967-9552
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000084219 | Medicaid | WI |
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 |
|---|---|---|---|
| 608057 | WI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jeffrey L Polczinski PSYD LLC | Past | Accepting new patients | |
| Associated Mental Health Services | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Milwaukee, WI
- NPI 1649338120
-
- Psychologist
- Glendale, WI
- NPI 1124291976
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374019200000",
"number": "1316907694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5555 NORTH PORT WASHINGTON RD",
"address_2": "STE 304",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532174927",
"telephone_number": "414-967-9552",
"fax_number": "414-967-9550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5555 NORTH PORT WASHINGTON RD",
"address_2": "STE 304",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532174927",
"telephone_number": "414-967-9552",
"fax_number": "414-967-9550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ADESSO",
"first_name": "VINCENT",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-23",
"last_updated": "2013-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "608057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000084219",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.