Provider Demographics
NPI:1548775190
Name:NEURODEVELOPMENTAL EDUCATIONAL SERVICES, PLLC
Entity Type:Organization
Organization Name:NEURODEVELOPMENTAL EDUCATIONAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-777-1270
Mailing Address - Street 1:26 EDGEHILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7722
Mailing Address - Country:US
Mailing Address - Phone:617-777-1270
Mailing Address - Fax:617-307-4052
Practice Address - Street 1:26 EDGEHILL ROAD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445
Practice Address - Country:US
Practice Address - Phone:617-777-1270
Practice Address - Fax:617-307-4052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7942103G00000X
MA1134921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty