Active NPI
Michael Perovich, PSYD
- Psychologist
- Allentown, PA
National Provider Identifier
1457102113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS-005177-L
- Practice address
- 1150 Glenlivet Dr Ste A18
Allentown, PA 18106-3112 - Phone
- (484) 358-1736
- NPI assigned
- Apr 1, 2024
- Last updated
- Apr 1, 2024
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS-005177-L | PA | Primary |
Addresses
Primary practice location
1150 Glenlivet Dr Ste A18
Allentown, PA 18106-3112
Mailing address
1150 Glenlivet Dr Ste A18
Allentown, PA 18106-3112
Phone (484) 358-1736
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2014 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS-005177-L | PA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711929600000",
"number": "1457102113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1150 GLENLIVET DR STE A18",
"city": "ALLENTOWN",
"state": "PA",
"postal_code": "181063112",
"telephone_number": "484-358-1736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1150 GLENLIVET DR STE A18",
"city": "ALLENTOWN",
"state": "PA",
"postal_code": "181063112",
"telephone_number": "484-358-1736"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEROVICH",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-04-01",
"last_updated": "2024-04-01",
"certification_date": "2024-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS-005177-L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Allentown, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.