Provider Demographics
NPI:1407365794
Name:PIECE OF MIND NEUROPSYCHOLOGY INC.
Entity Type:Organization
Organization Name:PIECE OF MIND NEUROPSYCHOLOGY INC.
Other - Org Name:PIECE OF MIND NEUROPSYCHOLOGY LLC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIKOLIC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-221-7990
Mailing Address - Street 1:PO BOX 721034
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92172-1034
Mailing Address - Country:US
Mailing Address - Phone:720-715-2212
Mailing Address - Fax:888-388-2142
Practice Address - Street 1:4660 LA JOLLA VILLAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-4604
Practice Address - Country:US
Practice Address - Phone:858-769-4464
Practice Address - Fax:888-388-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8438103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty