Michael James Jenuwine, PH.D.

Primary specialty

Forensic PsychologistTaxonomy code 103TF0200X

License

20041826A Issued in IN

Practice address

725 Howard St
South Bend, IN 46617-1529

Phone

(574) 631-7795

Fax

(574) 631-6725

NPI assigned

Jun 21, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336345008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 HOWARD ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171529",
            "telephone_number": "574-631-7795",
            "fax_number": "574-631-6725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 HOWARD ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171529",
            "telephone_number": "574-631-7795",
            "fax_number": "574-631-6725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENUWINE",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "IN",
            "license": "20041826A",
            "primary": true
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Forensic Psychologist in South Bend, IN
• Providers in South Bend, IN by specialty
• Forensic Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.