Provider Demographics
NPI:1053506246
Name:NEUROBEHAVIORAL SERVICES, PSC
Entity Type:Organization
Organization Name:NEUROBEHAVIORAL SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARBARY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:859-373-0133
Mailing Address - Street 1:261 REGENCY CIR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2348
Mailing Address - Country:US
Mailing Address - Phone:859-373-0133
Mailing Address - Fax:859-373-8119
Practice Address - Street 1:261 REGENCY CIR
Practice Address - Street 2:SUITE 4
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2348
Practice Address - Country:US
Practice Address - Phone:859-373-0133
Practice Address - Fax:859-373-8119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1308103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP77917Medicare UPIN