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CHILD&FAMILY INSTITUTE FOR ASSESSMENT AND PSYCHOTHERAPY, LLC

Clinical Neuropsychologist

Park City, Utah

Provider NPI: 1902865595

Organization Information:
Organization Name:  CHILD&FAMILY INSTITUTE FOR ASSESSMENT AND PSYCHOTHERAPY, LLC
Authorized Official:  JENNIFER SANTOSUSSO GALE  OWNER/PEDIATRIC NEUROPSYCHOLOGIST  435-6459240

Practice Location:
1910 PROSPECTOR AVE SUITE 201 PARK CITY, UT 84060 US
Tel: 435-645-9240  Fax: 435-645-9237

Business Mailing Address:
1910 PROSPECTOR AVE SUITE 201 PARK CITY, UT 84060 US
Tel: 435-645-9240  Fax: 435-645-9237

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
UT377761-2501

Other Provider Identifiers:

IssuerNumberStateType
149727806001UT05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







CLINICAL NEUROPSYCHOLOGIST JOBS UT - Page 1

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