NPIMap

Organization Active NPI

Clinical & Forensic Psychological Services of Indiana, P.C.

  • Clinical Psychologist
  • Fort Wayne, IN
National Provider Identifier
1821208000
Registry record updated Mar 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
20040536A Issued in IN
Legal business name
CLINICAL & FORENSIC PSYCHOLOGICAL SERVICES OF INDIANA, P.C.
Practice address
4630 W Jefferson Blvd
Suite 5
Fort Wayne, IN 46804-6856
Phone
(260) 436-4100
Fax
(260) 432-6282
NPI assigned
May 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2008

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

Authorized official

Name
Dr. Stephen Gerard Ross, PSYDNPI 1467458695
Title
Psychologist
Phone
(260) 436-4100

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 PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 20040536A IN Primary

Addresses

Primary practice location

4630 W Jefferson Blvd
Suite 5
Fort Wayne, IN 46804-6856

Mailing address

4630 W Jefferson Blvd
Suite 5
Fort Wayne, IN 46804-6856
Phone (260) 436-4100

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204502400000",
    "number": "1821208000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4630 W JEFFERSON BLVD",
            "address_2": "SUITE 5",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046856",
            "telephone_number": "260-436-4100",
            "fax_number": "260-432-6282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4630 W JEFFERSON BLVD",
            "address_2": "SUITE 5",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046856",
            "telephone_number": "260-436-4100",
            "fax_number": "260-432-6282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL & FORENSIC PSYCHOLOGICAL SERVICES OF INDIANA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2008-03-03",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "GERARD",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "260-436-4100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20040536A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2008; 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.