West Side Family Mental Health Clinic, P.C.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0822 Issued in MI

Legal business name

WEST SIDE FAMILY MENTAL HEALTH CLINIC, P.C.

Practice address

352 Blue Star Hwy
Blue Star Professional BLDG.
South Haven, MI 49090-7102

Phone

(269) 637-1170

Fax

(269) 639-1312

NPI assigned

Aug 21, 2007

Last updated

Sep 6, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Adolph O. Di Loreto, PH.D.NPI 1437121381

Title

President

Phone

(269) 637-1170

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Adolph Otto Di Loreto, PH.D.

  • Clinical Psychologist
  • South Haven, MI
  • NPI 1437121381
  NPD (past) Authorized official
• Dennis Michael Beaufait, ED D

  • Clinical Psychologist
  • Santa Fe, NM
  • NPI 1538277058
  NPD (past)

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

{
    "created_epoch": "1187654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189036800000",
    "number": "1194918466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "352 BLUE STAR HWY",
            "address_2": "BLUE STAR PROFESSIONAL BLDG.",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490907102",
            "telephone_number": "269-637-1170",
            "fax_number": "269-639-1312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "352 BLUE STAR HWY",
            "address_2": "BLUE STAR PROFESSIONAL BLDG.",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490907102",
            "telephone_number": "269-637-1170",
            "fax_number": "269-639-1312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST SIDE FAMILY MENTAL HEALTH CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-21",
        "last_updated": "2007-09-06",
        "status": "A",
        "authorized_official_last_name": "DI LORETO",
        "authorized_official_first_name": "ADOLPH",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "269-637-1170",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "0822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Watt, PHARM. D.
• Sarah Elizabeth Wayner-Bristol
• Christopher Wendling, AT
• Wendy Dykstra LLC
• James L. Wertheimer, PA
• Kimberly Wilkes
• Rosita Evat Williams, CHW
• Robert Winter
• Marcus Wollak
• Daniel Robert Worthington, PHARM.D.

• Clinical Psychologist in South Haven, MI
• Providers in South Haven, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2007; 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.