Active NPI
Charles Anthony Decarlo, TLLP
- Clinical Psychologist
- Livonia, MI
National Provider Identifier
1699668889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6362010154APP25
- Practice address
- 15127 Bainbridge St
Livonia, MI 48154-3649 - Phone
- (734) 771-5788
- NPI assigned
- May 29, 2025
- 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 | 6362010154APP25 | MI | Primary |
Addresses
Primary practice location
15127 Bainbridge St
Livonia, MI 48154-3649
Mailing address
15127 Bainbridge St
Livonia, MI 48154-3649
Phone (734) 771-5788
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6362010154APP25 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1748476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748476800000",
"number": "1699668889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15127 BAINBRIDGE ST",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481543649",
"telephone_number": "734-771-5788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15127 BAINBRIDGE ST",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481543649",
"telephone_number": "734-771-5788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DECARLO",
"first_name": "CHARLES",
"middle_name": "ANTHONY",
"credential": "TLLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-05-29",
"last_updated": "2025-05-29",
"certification_date": "2025-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6362010154APP25",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.