NPIMap

Organization Active NPI

Developmental Neuropsychological Services, P.C.

  • Clinical Neuropsychologist
  • South Bend, IN
National Provider Identifier
1861874869
Registry record updated Jun 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
20042553A Issued in IN
Legal business name
DEVELOPMENTAL NEUROPSYCHOLOGICAL SERVICES, P.C.
Practice address
3608 Pleasant St
South Bend, IN 46615-2033
Phone
(574) 367-2371
NPI assigned
Jun 25, 2015
Last updated
Jun 25, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2015

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

Authorized official

Name
Chad Edwards, PH.D.NPI 1487924171
Title
Owner/President
Phone
(574) 855-7169

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X 20042553A IN Primary
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X 20042553A IN
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 20042553A IN
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X 20042553A IN

Addresses

Primary practice location

3608 Pleasant St
South Bend, IN 46615-2033

Mailing address

3608 Pleasant St
South Bend, IN 46615-2033
Phone (574) 367-2371

National Provider Directory

National Provider Directory

Locations

3608 Pleasant St
South Bend, IN 46615
Phone (574) 287-5968

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": "1435190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435190400000",
    "number": "1861874869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3608 PLEASANT ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466152033",
            "telephone_number": "574-367-2371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3608 PLEASANT ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466152033",
            "telephone_number": "574-367-2371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEVELOPMENTAL NEUROPSYCHOLOGICAL SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-25",
        "last_updated": "2015-06-25",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "574-855-7169",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "IN",
            "license": "20042553A",
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "IN",
            "license": "20042553A",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20042553A",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IN",
            "license": "20042553A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jun 25, 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.