Provider Demographics
NPI:1265046098
Name:AXON PSYCHOLOGY GROUP, PC
Entity Type:Organization
Organization Name:AXON PSYCHOLOGY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTARDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPP-CN
Authorized Official - Phone:617-435-9641
Mailing Address - Street 1:2500 NILES RD STE 5
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3225
Mailing Address - Country:US
Mailing Address - Phone:269-281-0408
Mailing Address - Fax:269-281-4065
Practice Address - Street 1:2500 NILES RD STE 5
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3225
Practice Address - Country:US
Practice Address - Phone:269-281-0408
Practice Address - Fax:269-281-4065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty