Individual provider Active NPI

Leonard Julius Santarsiero, PH.D.

  • Clinical Psychologist
  • Glastonbury, CT
National Provider Identifier
1477690147
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
001634 Issued in CT
Practice address
62 Talcott Rd
Glastonbury, CT 06033-2919
Phone
(860) 633-9490
Fax
(860) 633-9947
NPI assigned
Jan 31, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 001634 CT Primary

Addresses

Primary practice location

62 Talcott Rd
Glastonbury, CT 06033-2919

Mailing address

62 Talcott Rd
Glastonbury, CT 06033-2919
Phone (860) 633-9490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080904000589 CT Practitioner - Clinical Psychologist 3375619943 Practice locations: Glastonbury, CT

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

62 Talcott Rd
Glastonbury, CT 06033-2919
Phone (860) 633-9490

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
001634CTMDRegistered Dietitian

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477690147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 TALCOTT RD",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332919",
            "telephone_number": "860-633-9490",
            "fax_number": "860-633-9947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 TALCOTT RD",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332919",
            "telephone_number": "860-633-9490",
            "fax_number": "860-633-9947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTARSIERO",
        "first_name": "LEONARD",
        "middle_name": "JULIUS",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "001634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glastonbury, CT

Sources for this page

Verify at the official NPI Registry.