NPIMap

Organization Active NPI

Carolyn J Heineman PHD LLC

  • Clinical Psychologist
  • Portage, MI
National Provider Identifier
1689965329
Registry record updated Apr 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301013201 Issued in MI
Legal business name
CAROLYN J HEINEMAN PHD LLC
Practice address
5228 Lovers LN
Suite 104
Portage, MI 49002-1521
Phone
(269) 345-7101
Fax
(269) 345-7101
NPI assigned
Apr 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2011

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

Authorized official

Name
Carolyn J Heineman
Title
President
Phone
(269) 345-7101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 6301013201 MI Primary

Addresses

Primary practice location

5228 Lovers LN
Suite 104
Portage, MI 49002-1521

Mailing address

5228 Lovers LN
Suite 104
Portage, MI 49002-1521
Phone (269) 345-7101

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1303948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303948800000",
    "number": "1689965329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5228 LOVERS LN",
            "address_2": "SUITE 104",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490021521",
            "telephone_number": "269-345-7101",
            "fax_number": "269-345-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5228 LOVERS LN",
            "address_2": "SUITE 104",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490021521",
            "telephone_number": "269-345-7101",
            "fax_number": "269-345-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLYN J HEINEMAN PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-28",
        "last_updated": "2011-04-28",
        "status": "A",
        "authorized_official_last_name": "HEINEMAN",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "269-345-7101"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301013201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2011; 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.