DR. DOMENICK TIRABASSI IV PSYD
NPI 1023662459
Psychologist in Fond Du Lac, WI

Active since July 24, 2019PECOS Enrolled
420 E DIVISION ST, FOND DU LAC, WI 54935(920) 926-8492(920) 926-8903 Get Directions Write a Review

NPPES record last updated: August 31, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 31, 2023, Aug 1, 2019, Jul 24, 2019 (3 updates tracked since 2019).

About Dr. Domenick Tirabassi Iv Psyd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DOMENICK TIRABASSI IV PSYD (NPI 1023662459) is an individual psychologist in Fond Du Lac, Wisconsin, licensed in Wisconsin (5089-57) and active in the NPI registry since July 2019. He is enrolled in Medicare PECOS and maintains a secondary practice location in Milwaukee.

NPPES Registry Identity

NPI1023662459
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameDR. DOMENICK TIRABASSI IVCredential: PSYD
Location Address420 E DIVISION STFond Du Lac, WI 54935-4560
Mailing Address420 E Division StFond Du Lac, WI 54935-4560 · (920) 926-8492
Fax(920) 926-8903
Sole ProprietorNo
Enumeration DateJuly 24, 2019
Last NPPES UpdateAugust 31, 20243 updates tracked since enumeration
NPPES CertifiedAugust 31, 2024
NPI 1023662459 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in WI · 5089-57
Definition

A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

420 E DIVISION ST, Fond Du Lac, WI 54935

Secondary Practice Location 1

Location 110425 W North Ave Ste 350Milwaukee, WI 53226-2416 · Phone (414) 522-7899

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Dr. Domenick Tirabassi Iv Psyd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner
420 E DIVISION ST
FOND DU LAC, WI 54935
Obstetrics & Gynecology
420 E DIVISION ST
FOND DU LAC, WI 54935
Urology
420 E DIVISION ST
FOND DU LAC, WI 54935
Nurse Practitioner (Psychiatric/Mental Health)
420 E DIVISION ST
FOND DU LAC, WI 54935
Nurse Practitioner
420 E DIVISION ST
FOND DU LAC, WI 54935
Nurse Practitioner (Family)
420 E DIVISION ST
FOND DU LAC, WI 54935
Urology
420 E DIVISION ST
FOND DU LAC, WI 54935
Pediatrics
420 E DIVISION ST
FOND DU LAC, WI 54935

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Domenick Tirabassi's NPI number?

The NPI number for Domenick Tirabassi is 1023662459. It was assigned to this individual provider in the NPPES registry on July 24, 2019.

Where is Domenick Tirabassi located?

Domenick Tirabassi practices at 420 E Division St, Fond Du Lac, WI 54935. The listed phone number is (920) 926-8492.

What is Domenick Tirabassi's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Domenick Tirabassi enrolled in Medicare?

Yes. Domenick Tirabassi is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Domenick Tirabassi was last updated on August 31, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.