Provider Demographics
NPI:1093583593
Name:NEUROPSYCHOLOGY ME PLLC
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGY ME PLLC
Other - Org Name:NEUROPSYCH.ME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL AND FORENSIC PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-777-3258
Mailing Address - Street 1:539 W COMMERCE ST # 3060
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-1953
Mailing Address - Country:US
Mailing Address - Phone:949-370-9442
Mailing Address - Fax:361-353-4408
Practice Address - Street 1:539 W. COMMERCE STREET
Practice Address - Street 2:SUITE #3060
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-1953
Practice Address - Country:US
Practice Address - Phone:972-777-3258
Practice Address - Fax:361-353-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003075235OtherNPI
CA1669621926OtherNPI