Carla Frances Antenucci, PSYD
Individual provider Active NPI Clinical Psychologist · Cincinnati, OH
NPI 1689299539 · NPPES record last updated Jun 16, 2020
Key facts
- NPI
- 1689299539
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- P.08015 (OH)
- Practice address
- 7105 Hamilton Ave
Cincinnati, OH 45231-5218 - Phone
- (513) 522-0777
- NPI assigned
- Jun 16, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Legacy Psychological Services, LLC
Practice addresses (Care Compare)
7105 Hamilton Ave
Cincinnati, OH 45231-5218
Phone (513) 522-0777
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200623002703 | OH | Practitioner - Clinical Psychologist | 6608298534 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P.08015 | OH | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Psychological Services, LLC | Clinical | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | P.08015 | OH | Yes |
Addresses
Primary practice location
7105 Hamilton Ave
Cincinnati, OH 45231-5218
Mailing address
7105 Hamilton Ave
Cincinnati, OH 45231-5218
Phone (513) 522-0777
Other providers in Cincinnati, OH
- Elizabeth Ansari
- Najamul H. Ansari
- Ashlie Laurin Ansley
- Geoffrey Answini
- Jennifer Marie Anteau
- ABA Mboraba Anthony
- Chyna Anthony
- F Kate Anthony
- Mahogany Dominique Anthony
- Irena Antic
All providers in Cincinnati, OH · Clinical Psychologist in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.