Provider Demographics
NPI:1730656844
Name:NOVA NEUROPSYCHOLOGY LLC
Entity Type:Organization
Organization Name:NOVA NEUROPSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WROCKLAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-479-0554
Mailing Address - Street 1:110 WASHINGTON AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1723
Mailing Address - Country:US
Mailing Address - Phone:203-479-0554
Mailing Address - Fax:833-411-6631
Practice Address - Street 1:110 WASHINGTON AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1723
Practice Address - Country:US
Practice Address - Phone:203-479-0554
Practice Address - Fax:833-411-6631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty