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Clinical Neuropsychologist

Phoenix, Arizona

Provider NPI: 1437264868

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 602-406-3671  Fax: 602-406-6115

Business Mailing Address:
FILE 56765  LOS ANGELES, CA 90074 US
Tel: 602-406-3860  Fax: 602-406-6132

Entity Type: Individual


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

Other Provider Identifiers:

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


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