NPIMap

Organization Active NPI

Midamerican Psychological Institute PC

  • Clinical Psychologist
  • Joliet, IL
National Provider Identifier
1366558553
Registry record updated Nov 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071006470 Issued in IL
Legal business name
MIDAMERICAN PSYCHOLOGICAL INSTITUTE PC
Practice address
1415 Maple Rd
Joliet, IL 60432-1442
Phone
(815) 735-0732
Fax
(815) 722-7310
NPI assigned
Aug 21, 2006
Last updated
Nov 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2012

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

Authorized official

Name
Dr. Daniel J Moran, PHD BCBANPI 1649386830
Title
Owner
Phone
(815) 735-0732

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071006470 IL Primary

Addresses

Primary practice location

1415 Maple Rd
Joliet, IL 60432-1442

Mailing address

1415 Maple Rd
Joliet, IL 60432-1442
Phone (815) 735-0732

Other identifiers 1

IdentifierTypeStateIssuer
9932152OtherILBCBS GROUP NUMBER

National Provider Directory

National Provider Directory

Locations

1415 Maple Rd
Joliet, IL 60432
Phone (815) 735-0732

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354060800000",
    "number": "1366558553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 MAPLE RD",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604321442",
            "telephone_number": "815-735-0732",
            "fax_number": "815-722-7310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 MAPLE RD",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604321442",
            "telephone_number": "815-735-0732",
            "fax_number": "815-722-7310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDAMERICAN PSYCHOLOGICAL INSTITUTE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2012-11-28",
        "status": "A",
        "authorized_official_last_name": "MORAN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-735-0732",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD BCBA"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071006470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "9932152",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; 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.