Provider Demographics
NPI:1164995023
Name:MINDFUL NEUROPSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:MINDFUL NEUROPSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NEHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DIXIT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-910-3652
Mailing Address - Street 1:1349 INDIAN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3321
Mailing Address - Country:US
Mailing Address - Phone:352-682-3655
Mailing Address - Fax:
Practice Address - Street 1:940 E HAVERFORD RD STE 303
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3859
Practice Address - Country:US
Practice Address - Phone:215-910-3652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty