Provider Demographics
NPI:1164697736
Name:SOUTHERN ARIZONA NEUROPSYCHOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:SOUTHERN ARIZONA NEUROPSYCHOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:T
Authorized Official - Last Name:CAFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-329-8298
Mailing Address - Street 1:403 W COOL DR STE 107
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6551
Mailing Address - Country:US
Mailing Address - Phone:520-329-8298
Mailing Address - Fax:520-329-8311
Practice Address - Street 1:403 W COOL DR STE 107
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-329-8298
Practice Address - Fax:520-329-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2023103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ329222Medicaid
AZ329222Medicaid