Provider Demographics
NPI:1629108519
Name:CHILDREN'S NEUROPSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:CHILDREN'S NEUROPSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LABARGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-439-1641
Mailing Address - Street 1:834 KENWOOD AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9601
Mailing Address - Country:US
Mailing Address - Phone:518-439-1641
Mailing Address - Fax:518-439-1625
Practice Address - Street 1:834 KENWOOD AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9601
Practice Address - Country:US
Practice Address - Phone:518-439-1641
Practice Address - Fax:518-439-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014976103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty