Provider Demographics
NPI:1043702509
Name:NEURODEVELOPMENTAL ASSESSMENT AND CONSULTING, LLC
Entity Type:Organization
Organization Name:NEURODEVELOPMENTAL ASSESSMENT AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANFREDI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:215-515-2388
Mailing Address - Street 1:3331 STREET RD STE 407
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2023
Mailing Address - Country:US
Mailing Address - Phone:215-515-2388
Mailing Address - Fax:
Practice Address - Street 1:3331 STREET RD STE 407
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020
Practice Address - Country:US
Practice Address - Phone:215-515-2388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016960103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty