Provider Demographics
NPI:1578619268
Name:NEUROPSYCHOLOGY & FORENSIC PSYCHOLOGY SPECIALTY SERVICES LTD
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGY & FORENSIC PSYCHOLOGY SPECIALTY SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GALIT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DORI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-464-4440
Mailing Address - Street 1:23360 CHAGRIN BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5537
Mailing Address - Country:US
Mailing Address - Phone:440-464-4440
Mailing Address - Fax:
Practice Address - Street 1:23360 CHAGRIN BLVD
Practice Address - Street 2:STE 103
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5537
Practice Address - Country:US
Practice Address - Phone:440-464-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9366831Medicare PIN
CP29772Medicare PIN