Individual provider Active NPI

Laurie Sackett-Maniacci, PSY.D.

  • Psychologist
  • Naperville, IL
National Provider Identifier
1376870436
Registry record updated Nov 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
071-006271 Issued in IL
Practice address
1555 Naperville Wheaton Rd
Suite 108B
Naperville, IL 60563-1557
Phone
(630) 548-4745
NPI assigned
Nov 11, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 11, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 071-006271 IL Primary

Addresses

Primary practice location

1555 Naperville Wheaton Rd
Suite 108B
Naperville, IL 60563-1557

Mailing address

1555 Naperville Wheaton Rd
Suite 108B
Naperville, IL 60563-1557
Phone (630) 548-4745

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071-006271ILMDPsychologist

NPI Registry JSON

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

{
    "created_epoch": "1257897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257897600000",
    "number": "1376870436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 NAPERVILLE WHEATON RD",
            "address_2": "SUITE 108B",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605631557",
            "telephone_number": "630-548-4745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 NAPERVILLE WHEATON RD",
            "address_2": "SUITE 108B",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605631557",
            "telephone_number": "630-548-4745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SACKETT-MANIACCI",
        "first_name": "LAURIE",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-11",
        "last_updated": "2009-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071-006271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2009; 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.