Provider Demographics
NPI:1003330408
Name:COGNITIVE CONSULTS AND TECHNOLOGY LLC
Entity Type:Organization
Organization Name:COGNITIVE CONSULTS AND TECHNOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-808-4667
Mailing Address - Street 1:3604 WHITEHAVEN PKWY NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007
Mailing Address - Country:US
Mailing Address - Phone:410-808-4667
Mailing Address - Fax:202-621-7666
Practice Address - Street 1:3020 HAMAKER COURT, SUITE 103
Practice Address - Street 2:NEUROPSYCHOLOGY ASSOCIATES OF FAIRFAX
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-876-0966
Practice Address - Fax:703-876-1628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004396103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty