Provider Demographics
NPI:1346968690
Name:NEUROPSYCHOLOGICAL CONSULTING SERVICES
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGICAL CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:DORAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:443-962-7715
Mailing Address - Street 1:1110 BENFIELD BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2644
Mailing Address - Country:US
Mailing Address - Phone:443-962-7715
Mailing Address - Fax:410-962-4710
Practice Address - Street 1:1110 BENFIELD BLVD STE H
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2644
Practice Address - Country:US
Practice Address - Phone:443-962-7715
Practice Address - Fax:410-962-4710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD253506800Medicaid