Active NPI
Madine R Desantis, PHD
- Clinical Psychologist
- Highland Park, NJ
National Provider Identifier
1841514189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 35S100485400
- Practice address
- 307 Raritan Avenue
Highland Park, NJ 08904 - Phone
- (732) 253-0755
- NPI assigned
- Mar 15, 2010
- Last updated
- May 6, 2020
- Sex
- Female
- 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 | 35S100485400 | NJ | Primary |
Addresses
Primary practice location
307 Raritan Avenue
Highland Park, NJ 08904
Mailing address
307 Raritan Avenue
Highland Park, NJ 08904
Phone (732) 253-0755
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35S100485400 | NJ | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588723200000",
"number": "1841514189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "307 RARITAN AVENUE",
"city": "HIGHLAND PARK",
"state": "NJ",
"postal_code": "08904",
"telephone_number": "732-253-0755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 RARITAN AVENUE",
"city": "HIGHLAND PARK",
"state": "NJ",
"postal_code": "08904",
"telephone_number": "732-253-0755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESANTIS",
"first_name": "MADINE",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-03-15",
"last_updated": "2020-05-06",
"certification_date": "2020-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "35S100485400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Highland Park, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.