Active NPI
Joseph A Micucci, PH.D., ABPP
- Clinical Psychologist
- Media, PA
National Provider Identifier
1326098344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS4460L
- Practice address
- 36 E Front St
Media, PA 19063-2936 - Phone
- (610) 527-4255
- Fax
- (610) 527-4189
- NPI assigned
- May 11, 2006
- Last updated
- Jul 8, 2007
- 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 | PS4460L | PA | Primary |
Addresses
Primary practice location
36 E Front St
Media, PA 19063-2936
Mailing address
460 Garrison Way
Conshohocken, PA 19428-2516
Phone (610) 527-4255
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS4460L | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1326098344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "460 GARRISON WAY",
"city": "CONSHOHOCKEN",
"state": "PA",
"postal_code": "194282516",
"telephone_number": "610-527-4255",
"fax_number": "610-527-4189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 E FRONT ST",
"city": "MEDIA",
"state": "PA",
"postal_code": "190632936",
"telephone_number": "610-527-4255",
"fax_number": "610-527-4189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICUCCI",
"first_name": "JOSEPH",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PH.D., ABPP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS4460L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Media, PA
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.