Provider Demographics
NPI:1689058414
Name:CLINICAL NEUROPSYCHOLOGY PC
Entity Type:Organization
Organization Name:CLINICAL NEUROPSYCHOLOGY PC
Other - Org Name:PSYCHOLOGICAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SIBILLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:574-232-4453
Mailing Address - Street 1:218 W WASHINGTON ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1800
Mailing Address - Country:US
Mailing Address - Phone:574-232-4453
Mailing Address - Fax:574-232-7718
Practice Address - Street 1:218 W WASHINGTON ST
Practice Address - Street 2:SUITE 800
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1800
Practice Address - Country:US
Practice Address - Phone:574-232-4453
Practice Address - Fax:574-232-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty