Provider Demographics
NPI:1043453137
Name:NEAL MCGRATH, PH.D. & ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:NEAL MCGRATH, PH.D. & ASSOCIATES, P.C.
Other - Org Name:SPORTS CONCUSSION NEW ENGLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-959-1010
Mailing Address - Street 1:1368 BEACON ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2872
Mailing Address - Country:US
Mailing Address - Phone:617-959-1010
Mailing Address - Fax:
Practice Address - Street 1:1368 BEACON ST
Practice Address - Street 2:SUITE 116
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2872
Practice Address - Country:US
Practice Address - Phone:617-959-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3972103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04054Medicare UPIN