Paul W Macellari PHD PC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

20040273 Issued in IN

Legal business name

PAUL W MACELLARI PHD PC

Practice address

135 Red Coach Dr
Mishawaka, IN 46545-3145

Phone

(574) 254-9200

Fax

(574) 254-9202

NPI assigned

May 21, 2015

Last updated

May 21, 2015By 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. Paul Warren Macellari, PHD

Title

President

Phone

(574) 254-9200

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432166400000",
    "number": "1285013474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 RED COACH DRIVE",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453145",
            "telephone_number": "574-254-9200",
            "fax_number": "574-254-9202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 RED COACH DR",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453145",
            "telephone_number": "574-254-9200",
            "fax_number": "574-254-9202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL W MACELLARI PHD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-21",
        "last_updated": "2015-05-21",
        "status": "A",
        "authorized_official_last_name": "MACELLARI",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "WARREN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-254-9200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IN",
            "license": "20040273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2015; 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.