Active NPI
Michael Libertazzo, ED.D.
- Counseling Psychologist
- Princeton, NJ
National Provider Identifier
1730243023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- PSYCHOLOGIST #2370
- Practice address
- 112 Rollingmead St
Princeton, NJ 08540-4068 - Phone
- (609) 921-6264
- Fax
- (609) 921-1998
- NPI assigned
- Dec 20, 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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | PSYCHOLOGIST #2370 | NJ | Primary |
Addresses
Primary practice location
112 Rollingmead St
Princeton, NJ 08540-4068
Mailing address
112 Rollingmead St
Princeton, NJ 08540-4068
Phone (609) 921-6264
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2013 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSYCHOLOGIST #2370 | NJ | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730243023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 ROLLINGMEAD ST",
"city": "PRINCETON",
"state": "NJ",
"postal_code": "085404068",
"telephone_number": "609-921-6264",
"fax_number": "609-921-1998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 ROLLINGMEAD ST",
"city": "PRINCETON",
"state": "NJ",
"postal_code": "085404068",
"telephone_number": "609-921-6264",
"fax_number": "609-921-1998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIBERTAZZO",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "NJ",
"license": "PSYCHOLOGIST #2370",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Princeton, NJ
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.