Michael A Destefano, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS004910L Issued in PA

Practice address

14 S Bryn Mawr Ave
Suite 205
Bryn Mawr, PA 19010-3216

Phone

(610) 525-4828

NPI assigned

Dec 13, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2021 through Apr 1, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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

• Bradley C Norford PHD PC

  • Clinical Psychologist
  • Bryn Mawr, PA
  • NPI 1326180654
  NPD (past)

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

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323734400000",
    "number": "1982972378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 KENILWORTH RD",
            "city": "MERION STATION",
            "state": "PA",
            "postal_code": "190661309",
            "telephone_number": "610-246-2534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 S BRYN MAWR AVE",
            "address_2": "SUITE 205",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103216",
            "telephone_number": "610-525-4828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTEFANO",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-13",
        "last_updated": "2011-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS004910L",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS004910L",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "PA",
            "license": "PS004910L",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meredith Ann Denzine I, PA-C
• Marc Deodato, D.C.
• Anne Depapp, MD
• Theresa Leahey Depetris, P.T.
• Janet E Desipio, P.A.
• Vickie Ruth Detter, LSW
• William M Deuber Jr., PT
• Devereux Foundation
• Allison Devitis
• John Gerard Devlin Jr., M.D.

• Psychologist in Bryn Mawr, PA
• Providers in Bryn Mawr, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.