DR. MATTHEW PAUL ZICCARDI


Address: 2200 Randallia Dr, Fort Wayne, IN 46805
Phone: 2603734538

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).

Provider Overview

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

Taxonomy

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

Provider Secondary Practice Location

Address Telephone Number Fax Number
1045 Mackenzie Dr, Lima, OH 458051660 4192225672 4192226786

Office Location

Street Address 2200 RANDALLIA DR
City FORT WAYNE
State IN
Zip Code 46805

Providers in the same location

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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Providers in the same zip code

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 Information

Taxonomy Code 103G00000X
Grouping Behavioral Health & Social Service Providers
Classification Clinical Neuropsychologist

Taxonomy Definition

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]

Providers in the same taxonomy and city

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

Competitor

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City FORT WAYNE
Zip Code 46805

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Dataset Information

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.

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