Provider Demographics
NPI:1366490161
Name:FAMILY LEARNING CENTER
Entity Type:Organization
Organization Name:FAMILY LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BERARDI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:574-232-1405
Mailing Address - Street 1:211 W WASHINGTON ST
Mailing Address - Street 2:SUITE 1910
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1704
Mailing Address - Country:US
Mailing Address - Phone:574-232-1405
Mailing Address - Fax:574-232-0124
Practice Address - Street 1:211 W WASHINGTON ST
Practice Address - Street 2:SUITE 1910
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1704
Practice Address - Country:US
Practice Address - Phone:574-232-1405
Practice Address - Fax:574-232-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010290A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN217590Medicare PIN
IN218200Medicare PIN