Active NPI
Joanna Celeste Procaccini, PSY.D., NCSP
- Clinical Psychologist
- Milford, CT
National Provider Identifier
1891058780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 003411
- Practice address
- 203 Broad St
Suite C4
Milford, CT 06460-4751 - Phone
- (203) 850-0140
- Fax
- (888) 783-9125
- NPI assigned
- Jun 17, 2012
- 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 | 003411 | CT | Primary |
Addresses
Primary practice location
203 Broad St
Suite C4
Milford, CT 06460-4751
Mailing address
203 Broad St
Suite C4
Milford, CT 06460-4751
Phone (203) 850-0140
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891058780 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141103001497 | CT | Practitioner - Clinical Psychologist | 5092937292 | Practice locations: Milford, CT |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
203 Broad St
Unit C 4
Milford, CT 06460-4750
Phone (203) 850-0140
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003411 | CT | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432857600000",
"number": "1891058780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 BROAD ST",
"address_2": "SUITE C4",
"city": "MILFORD",
"state": "CT",
"postal_code": "064604751",
"telephone_number": "203-850-0140",
"fax_number": "888-783-9125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 BROAD ST",
"address_2": "SUITE C4",
"city": "MILFORD",
"state": "CT",
"postal_code": "064604751",
"telephone_number": "203-850-0140",
"fax_number": "888-783-9125"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROCACCINI",
"first_name": "JOANNA",
"middle_name": "CELESTE",
"name_prefix": "Dr.",
"credential": "PSY.D., NCSP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-17",
"last_updated": "2015-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "003411",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1891058780",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milford, CT
- Michael David Prezioso, LPC-A ATR-P
- Primary Care Solutions LLC
- Diane M Prior, L.C.S.W.
- Private Practice of Adrian Rodriguez Targa LCSW
- Proactive Health Care Management,LLC
- Sara Grace Procopio, LMSW
- Professional Dental Alliance of Milford, PLLC
- Professional Eyecare Associates, LLC
- Professional Psychotherapy Associates of Milford LLC
- Prolete Physical Therapy & Sports Medicine PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2015; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.