Individual provider Active NPI

Janet M Bertoldi, PH.D.

  • Psychologist
  • Bradenton, FL
National Provider Identifier
1750305587
Registry record updated Apr 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY9061 Issued in FL
Practice address
5325 26TH St W
Bradenton, FL 34207-3012
Phone
(941) 752-7173
Fax
(941) 567-6277
NPI assigned
Jul 26, 2006
Last updated
Apr 11, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 11, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PY9061 FL Primary
Clinical Psychologist 103TC0700X 002500 CT
Clinical Psychologist 103TC0700X 68015623 NY
Clinical Psychologist 103TC0700X PY9061 FL

Addresses

Primary practice location

5325 26TH St W
Bradenton, FL 34207-3012

Mailing address

700 8TH Ave W Ste 101
Palmetto, FL 34221-4737
Phone (941) 776-4000

Other identifiers 1

IdentifierTypeStateIssuer
11-3710578OtherCTLLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20181219000644 FL Practitioner - Clinical Psychologist 0446293195 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
68015623NYMDClinical Psychologist
002500CTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
MCR Health, Inc. CurrentSince Jan 4, 2019 Accepting new patients
MCR Health, Inc. CurrentSince Jan 4, 2019 Accepting new patients
Coastal Neuropsychology, LLC Clinical CurrentSince Jun 1, 2023 Accepting new patients

Locations

5325 26th St W
Bradenton, FL 34207
Phone (941) 708-8500

700 8th Ave W
Ste 101
Palmetto, FL 34221
Phone (941) 776-4008

12271 US Highway 301 N
Parrish, FL 34219
Phone (941) 713-2231

2415 University Pkwy
Ste 2
Sarasota, FL 34243
Phone (800) 687-1938

2415 University Pkwy
Ste 219
Sarasota, FL 34243
Phone (800) 687-1938

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554940800000",
    "number": "1750305587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 8TH AVE W STE 101",
            "city": "PALMETTO",
            "state": "FL",
            "postal_code": "342214737",
            "telephone_number": "941-776-4000",
            "fax_number": "941-845-4963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5325 26TH ST W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342073012",
            "telephone_number": "941-752-7173",
            "fax_number": "941-567-6277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTOLDI",
        "first_name": "JANET",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2019-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY9061",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "002500",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "68015623",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY9061",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LLC",
            "identifier": "11-3710578",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.