Andrea Teofilovic

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Practice address

315 Spring St
Big Rapids, MI 49307-1945

Phone

(310) 561-0301

NPI assigned

May 10, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1715299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1801644109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 SPRING ST",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493071945",
            "telephone_number": "310-561-0301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 SPRING ST",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493071945",
            "telephone_number": "310-561-0301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEOFILOVIC",
        "first_name": "ANDREA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-10",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Child & Adolescent Psychologist in Big Rapids, MI
• Providers in Big Rapids, MI by specialty
• Clinical Child & Adolescent Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; 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.