Individual provider Active NPI

Elizabeth Chaffee Halloran, PHD

  • Clinical Psychologist
  • Toledo, OH
National Provider Identifier
1568543304
Registry record updated Oct 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
5058 Issued in OH
Practice address
2200 Jefferson Ave
Toledo, OH 43604-7101
Phone
(419) 251-1400
Fax
(419) 251-1797
NPI assigned
Oct 18, 2006
Last updated
Oct 2, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 5058 OH Primary

Addresses

Primary practice location

2200 Jefferson Ave
Toledo, OH 43604-7101

Mailing address

2200 Jefferson Ave
Toledo, OH 43604-7101

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
I20090428000601 OH Practitioner - Clinical Psychologist 9436207594 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2200 Jefferson Ave
Toledo, OH 43604-7101
Phone (419) 251-1400

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5058OHMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians North Specialty Care LLC CurrentSince Oct 1, 2024 Accepting new patients
Mercy Health Physicians North Specialty Care LLC CurrentSince Oct 1, 2024 Accepting new patients
Mercy Health Physicians-North LLC CurrentSince Oct 15, 2020 Accepting new patients
Mercy Health Physicians - North, LLC CurrentSince Oct 15, 2020 Accepting new patients
Mercy Health - St Vincent Medical Center LLC Past Accepting new patients

Locations

2200 Jefferson Ave
Toledo, OH 43604
Phone (419) 241-1400

2213 Franklin Ave
Fl 2
Toledo, OH 43620
Phone (419) 251-2360

2222 Cherry St
Ste 2300
Toledo, OH 43608
Phone (419) 251-8013

3900 Sunforest Ct
Ste 240
Toledo, OH 43623
Phone (419) 472-3126

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1568543304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 JEFFERSON AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436047101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 JEFFERSON AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436047101",
            "telephone_number": "419-251-1400",
            "fax_number": "419-251-1797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLORAN",
        "first_name": "ELIZABETH",
        "middle_name": "CHAFFEE",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "5058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.