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Clinical Neuropsychologist

Port Jefferson, New York

Provider NPI: 1699742577

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 631-473-4652  Fax: 631-473-4652

Business Mailing Address:
Tel: 631-473-4652  Fax: 631-473-4652

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
N103TC0700XBehavioral Health & Social Service Providers


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