Provider Demographics
NPI:1467992453
Name:CENTER FOR NEUROPOTENTIAL
Entity Type:Organization
Organization Name:CENTER FOR NEUROPOTENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:475-221-8108
Mailing Address - Street 1:173 MONTOWESE ST
Mailing Address - Street 2:REAR UNIT
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3887
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:173 MONTOWESE ST
Practice Address - Street 2:REAR UNIT
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3887
Practice Address - Country:US
Practice Address - Phone:475-221-8108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CT002416103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty