Individual provider Active NPI

Rebecca Cipollone Antonacci, TLLP

  • Psychologist
  • Bingham Farms, MI
National Provider Identifier
1962355818
Registry record updated Feb 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6362010053 Issued in MI
Practice address
30200 Telegraph Rd Ste 207
Bingham Farms, MI 48025-5711
Phone
(248) 712-1129
Fax
(248) 792-3249
NPI assigned
Feb 19, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 19, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 6362010053 MI Primary

Addresses

Primary practice location

30200 Telegraph Rd Ste 207
Bingham Farms, MI 48025-5711

Mailing address

2015 Brockton Ave
Royal Oak, MI 48067-3513
Phone (248) 712-1129

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6362010053MIMDPsychologist

NPI Registry JSON

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

{
    "created_epoch": "1771459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771459200000",
    "number": "1962355818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 BROCKTON AVE",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480673513",
            "telephone_number": "248-712-1129",
            "fax_number": "248-792-3249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30200 TELEGRAPH RD STE 207",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480255711",
            "telephone_number": "248-712-1129",
            "fax_number": "248-792-3249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONACCI",
        "first_name": "REBECCA",
        "middle_name": "CIPOLLONE",
        "credential": "TLLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-02-19",
        "last_updated": "2026-02-19",
        "certification_date": "2026-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6362010053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bingham Farms, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.