DR. MATTHEW PAUL ZICCARDI (NPI# 1972508471) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1972508471 |
Entity Type | Individual |
Full Name | DR. MATTHEW PAUL ZICCARDI |
Credential | PSYD |
Practice Address |
2200 Randallia Dr Fort Wayne IN 46805 |
Mailing Address |
3702 New Vision Dr Bldg B Fort Wayne IN 46845-1703 |
Practice Telephone | 2603734538 |
Practice Fax Number | 2603739225 |
Enumeration Date | 2005-06-20 |
Last Update Date | 2019-11-14 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 103G00000X | Clinical Neuropsychologist | 20043298A | IN | Behavioral Health & Social Service Providers |
N | 103G00000X | Clinical Neuropsychologist | 5281 | OH | Behavioral Health & Social Service Providers |
Address | Telephone Number | Fax Number |
---|---|---|
1045 Mackenzie Dr, Lima, OH 458051660 | 4192225672 | 4192226786 |
Street Address |
2200 RANDALLIA DR |
City | FORT WAYNE |
State | IN |
Zip Code | 46805 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1891308896 | Cameron Buzzard | Physical Therapist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2020-08-28 |
1558985945 | Morgan Taylor Hilbert | Pharmacist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2020-06-02 |
1952941908 | Lydia Hentz | Counselor | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2020-01-07 |
1326683228 | Nicole Marie Gaunt | Social Worker | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-11-14 |
1205490877 | Elisha Lynn Handshoe | Physical Medicine & Rehabilitation | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-29 |
1154884898 | Monique Brissette | Speech-Language Pathologist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-10 |
1649733411 | Clarissa Burkett | Physical Therapy Assistant | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-09 |
1740743533 | Ross Tyler Nelson | Physical Therapist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-09 |
1295298982 | Jennifer Ferguson | Occupational Therapist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-09 |
1336602390 | Rachel Thompson | Pharmacist | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2019-04-08 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1619589546 | Connor Gemlick | Student in an Organized Health Care Education/Training Program | 1918 Carew St., Fort Wayne, IN 46805 | 2020-08-21 |
1710464086 | S.t.a.r. Care Services | Clinic/Center | 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 | 2018-07-19 |
1083122865 | Noel Shafi | Counselor | 3010 East State Boulevard, Fort Wayne, IN 46805 | 2018-01-16 |
1063963627 | Toni L Irby | Specialist | 3219 E State Blvd, Fort Wayne, IN 46805 | 2016-10-19 |
1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
1063817104 | Michale Diane Rothgeb | Physical Therapy Assistant | 2200 Randollia Dr, Fort Wayne, IN 46805 | 2014-10-31 |
1124435789 | Julia I. Mcfann | Physical Therapist | 2200 Randalia Dr, Fort Wayne, IN 46805 | 2014-07-16 |
1083036974 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 3320 East State Boulevard, Fort Wayne, IN 46805 | 2014-01-10 |
1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
1043595689 | Randy James Jennings | Pharmacist | 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 | 2011-10-14 |
Find all providers in zip 46805 |
Taxonomy Code | 103G00000X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Clinical Neuropsychologist |
An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1619275807 | Renee Elizabeth Buskirk | Clinical Neuropsychologist | 11143 Parkview Plaza Dr Ste 207, Fort Wayne, IN 46845-1728 | 2011-03-11 |
1780681254 | Frances R. Goff | Clinical Neuropsychologist | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1730 | 2005-06-30 |
1366911000 | Margarita M Nogin | Clinical Neuropsychologist | 4306 E State Blvd, Fort Wayne, IN 46815-6915 | 2018-11-23 |
1699196519 | Erin Miles | Clinical Neuropsychologist | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2013-12-19 |
1164860052 | Jacob Thomas Lutz | Clinical Neuropsychologist | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2013-06-13 |
1689995334 | Allied Physicians Inc | Clinical Neuropsychologist | 7956 W Jefferson Blvd, Fort Wayne, IN 46804-4140 | 2010-06-17 |
1669701793 | Christina M. Stemmler | Clinical Neuropsychologist | 11104 Parkview Circle Dr, Ste 110, Fort Wayne, IN 46845-1730 | 2009-12-21 |
1841524105 | Nivonne Thompson | Clinical Neuropsychologist | 2121 Lake Ave, Fort Wayne, IN 46805-5100 | 2009-09-18 |
1205098100 | Allied Physicians Inc | Clinical Neuropsychologist | 7956 W Jefferson Blvd, Fort Wayne, IN 46804-4140 | 2008-07-01 |
1134241227 | John J Brinkman Jr. | Clinical Neuropsychologist | 7956 W Jefferson Blvd, Fort Wayne, IN 46804-4140 | 2007-04-06 |
Find all providers in FORT WAYNE |
City | FORT WAYNE |
Zip Code | 46805 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.