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MICHELLE FANCIULLO PSY.D.
NPI 1144831082
Psychologist - Clinical Child & Adolescent in Hackensack, NJ

Active since August 13, 2020Opted out of Medicare · through Oct 28, 2027
12 2ND ST, HACKENSACK, NJ 07601(551) 996-8186 Get Directions Write a Review

NPPES record last updated: August 13, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Michelle Fanciullo Psy.d. NPPES

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

MICHELLE FANCIULLO PSY.D. (NPI 1144831082) is an individual clinical child & adolescent provider in Hackensack, New Jersey, licensed in New Jersey (35SI00623300) and active in the NPI registry since August 2020. She has opted out of Medicare through October 28, 2027.

NPPES Registry Identity

NPI1144831082
Entity TypeIndividualFemale
Primary Taxonomy103TC2200X
Provider Legal NameMICHELLE FANCIULLOCredential: PSY.D.
Location Address12 2ND STHackensack, NJ 07601-2009
Mailing Address30 Prospect AveHackensack, NJ 07601-1915
Phone(551) 996-8186
Sole ProprietorNo
Enumeration DateAugust 13, 2020
NPPES CertifiedAugust 13, 2020
✔ NPI 1144831082 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · Clinical Child & AdolescentBehavioral Health & Social Service Providers
Taxonomy Code103TC2200X
License✔ Licensed in NJ · 35SI00623300
Definition
A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology is an understanding of the basic psychological needs of children and adolescents, and how the family and other social contexts influence the socio-emotional adjustment, cognitive development, behavioral adaptation and health status of children and adolescents.
12 2ND ST, Hackensack, NJ 07601
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Michelle Fanciullo Psy.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 28, 2025 through October 28, 2027.

Opt-Out Effective DateOctober 28, 2025
Opt-Out In Effect ThroughOctober 28, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 5

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

DR. LAUREN CATHERINE WALLACE PHD
Psychologist (Clinical)
12 2ND ST
HACKENSACK, NJ 07601
Bergen County (551) 996-8186
ERICA REIFF
Psychologist (Clinical)
12 2ND ST
HACKENSACK, NJ 07601
Bergen County (551) 996-2271
MS. AMANDA ADDOLORATO MACDONALD PSYD
Psychologist (Clinical)
12 2ND ST
HACKENSACK, NJ 07601
Bergen County (917) 907-0766
JULIA ANGELINA DEBELLIS M.D.
Pediatrics (Child Abuse Pediatrics)
12 2ND ST
HACKENSACK, NJ 07601
Bergen County (551) 996-2271
MISS RUTH STREETER MESNARD PSY.D.
Psychologist (Clinical)
12 2ND ST
HACKENSACK, NJ 07601
Bergen County (551) 996-8056

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 Michelle Fanciullo's NPI number?

The NPI number for Michelle Fanciullo is 1144831082. It was assigned to this individual provider in the NPPES registry on August 13, 2020.

Where is Michelle Fanciullo located?

Michelle Fanciullo practices at 12 2nd St, Hackensack, NJ 07601. The listed phone number is (551) 996-8186.

What is Michelle Fanciullo's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical Child & Adolescent, with taxonomy code 103TC2200X.

Is Michelle Fanciullo enrolled in Medicare?

No. Michelle Fanciullo has opted out of Medicare through October 28, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Michelle Fanciullo was last updated on August 13, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.