Provider Demographics
NPI:1104037266
Name:BROOKLYN CENTER FOR PSYCHOLOGICAL & NEUROPSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:BROOKLYN CENTER FOR PSYCHOLOGICAL & NEUROPSYCHOLOGICAL SERVICES
Other - Org Name:LOIS M. BLACK, PH.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-941-2437
Mailing Address - Street 1:293 RUGBY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4551
Mailing Address - Country:US
Mailing Address - Phone:718-941-2437
Mailing Address - Fax:
Practice Address - Street 1:293 RUGBY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4551
Practice Address - Country:US
Practice Address - Phone:718-941-2437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010125.261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center