Individual provider Active NPI

Derek Mihalcin, PH.D.

  • Psychologist
  • Warren, OH
National Provider Identifier
1487078630
Registry record updated Feb 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
7108 Issued in OH
Practice address
1704 North Rd SE
Suite #2
Warren, OH 44484-2958
Phone
(330) 856-4111
Fax
(330) 856-5839
NPI assigned
Feb 8, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 8, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 7108 OH Primary

Addresses

Primary practice location

1704 North Rd SE
Suite #2
Warren, OH 44484-2958

Mailing address

1160 Albright McKay Rd
Hubbard, OH 44425-2848
Phone (330) 568-1835

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140507001720 OH Practitioner - Clinical Psychologist 2567695026 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
7108OHMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Oakwood Counseling Center Inc Psychologist CurrentSince Apr 19, 2014 Accepting new patients

Locations

1704 North Rd SE
Ste 2
Warren, OH 44484
Phone (330) 856-3178

1704 North Rd SE
Warren, OH 44484
Phone (330) 856-3633

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1391817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391817600000",
    "number": "1487078630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 ALBRIGHT MCKAY RD",
            "city": "HUBBARD",
            "state": "OH",
            "postal_code": "444252848",
            "telephone_number": "330-568-1835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 NORTH RD SE",
            "address_2": "SUITE #2",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444842958",
            "telephone_number": "330-856-4111",
            "fax_number": "330-856-5839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIHALCIN",
        "first_name": "DEREK",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-02-08",
        "last_updated": "2014-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "7108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, OH

Sources for this page

Verify at the official NPI Registry.