Provider Demographics
NPI:1083718381
Name:NEUROPSYCH OF LOS ALTOS, A PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:NEUROPSYCH OF LOS ALTOS, A PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:650-941-3002
Mailing Address - Street 1:24044 OAK KNOLL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-5100
Mailing Address - Country:US
Mailing Address - Phone:650-941-3002
Mailing Address - Fax:
Practice Address - Street 1:24044 OAK KNOLL CIR
Practice Address - Street 2:
Practice Address - City:LOS ALTOS HILLS
Practice Address - State:CA
Practice Address - Zip Code:94022-5100
Practice Address - Country:US
Practice Address - Phone:650-941-3002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty