Provider Demographics
NPI:1689625386
Name:TRIANGLE NEUROPSYCHOLOGY SERVICES, PLLC
Entity Type:Organization
Organization Name:TRIANGLE NEUROPSYCHOLOGY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HERFKENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-384-9682
Mailing Address - Street 1:3310 CROASDAILE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6806
Mailing Address - Country:US
Mailing Address - Phone:919-384-9682
Mailing Address - Fax:919-384-9683
Practice Address - Street 1:3310 CROASDAILE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6806
Practice Address - Country:US
Practice Address - Phone:919-384-9682
Practice Address - Fax:919-384-9683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2192103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5648716OtherAETNA
NC6000514Medicaid
NC974898OtherFIRST HEALTH
NC0376XOtherBLUE CROSS BLUE SHIELD
S210009Medicare UPIN
NC2816009AMedicare ID - Type UnspecifiedMEDICARE