Provider Demographics
NPI:1447604087
Name:NEUROLOFT LLC
Entity Type:Organization
Organization Name:NEUROLOFT LLC
Other - Org Name:LEARNINGRX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOFTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-462-9570
Mailing Address - Street 1:8321 OLD COURTHOUSE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3817
Mailing Address - Country:US
Mailing Address - Phone:703-462-9570
Mailing Address - Fax:703-890-1498
Practice Address - Street 1:8321 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3817
Practice Address - Country:US
Practice Address - Phone:703-462-9570
Practice Address - Fax:703-890-1498
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROLOFT HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-20
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003327103TC0700X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty