NPIMap

Organization Active NPI

Clinical Neuropsychology PC

Doing business as Psychological Health Center

  • Clinical Psychologist
  • South Bend, IN
National Provider Identifier
1689058414
Registry record updated Jul 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
CLINICAL NEUROPSYCHOLOGY PC
Doing business as
Psychological Health Center
Practice address
218 W Washington St
Suite 800
South Bend, IN 46601-1800
Phone
(574) 232-4453
Fax
(574) 232-7718
NPI assigned
Jul 10, 2015
Last updated
Jul 10, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2015

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

Authorized official

Name
Dr. Warren W Sibilla Jr., PH.D.NPI 1871790121
Title
Owner
Phone
(574) 232-4453

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 Primary

Addresses

Primary practice location

218 W Washington St
Suite 800
South Bend, IN 46601-1800

Mailing address

218 W Washington St
Suite 800
South Bend, IN 46601-1800
Phone (574) 232-4453

Other names 1

  • Psychological Health Center Doing business as

National Provider Directory

National Provider Directory

Locations

218 W Washington St
Ste 800
South Bend, IN 46601
Phone (574) 232-4453

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": "1436486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436486400000",
    "number": "1689058414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 W WASHINGTON ST",
            "address_2": "SUITE 800",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011800",
            "telephone_number": "574-232-4453",
            "fax_number": "574-232-7718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 W WASHINGTON ST",
            "address_2": "SUITE 800",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011800",
            "telephone_number": "574-232-4453",
            "fax_number": "574-232-7718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL NEUROPSYCHOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-10",
        "last_updated": "2015-07-10",
        "status": "A",
        "authorized_official_last_name": "SIBILLA",
        "authorized_official_first_name": "WARREN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-232-4453",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Psychological Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; 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.