Healthcare Provider Details

I. General information

NPI: 1518097575
Provider Name (Legal Business Name): CAESAR PACIFICI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S WALNUT ST
BLOOMINGTON IN
47404-6128
US

IV. Provider business mailing address

812 W 3RD ST
BLOOMINGTON IN
47404-5002
US

V. Phone/Fax

Practice location:
  • Phone: 812-650-2577
  • Fax:
Mailing address:
  • Phone: 812-331-2057
  • Fax: 812-331-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20042151A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: