Active NPI
Dominique Delalot, PH.D.
- Clinical Psychologist
- Philadelphia, PA
National Provider Identifier
1922358928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 68019607
- Practice address
- 3900 Woodland Avenue
Philadelphia Veterans Affairs Medi
Philadelphia, PA 19104 - Phone
- (205) 332-9129
- NPI assigned
- Sep 17, 2012
- Last updated
- Sep 17, 2012
- Sex
- Male
- Sole proprietor
- No
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 | 68019607 | NY | Primary |
Addresses
Primary practice location
3900 Woodland Avenue
Philadelphia Veterans Affairs Medi
Philadelphia, PA 19104
Mailing address
110 Recovery Rd
Bainbridge, GA 39819-6209
Phone (205) 332-9129
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 |
|---|---|---|---|
| 68019607 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347840000000",
"number": "1922358928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 RECOVERY RD",
"city": "BAINBRIDGE",
"state": "GA",
"postal_code": "398196209",
"telephone_number": "205-332-9129"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3900 WOODLAND AVENUE",
"address_2": "PHILADELPHIA VETERANS AFFAIRS MEDI",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19104",
"telephone_number": "205-332-9129"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELALOT",
"first_name": "DOMINIQUE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-17",
"last_updated": "2012-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "68019607",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.