Provider Demographics
NPI:1922276484
Name:NEUROPSYCHOLOGY & PSYCHOLOGY SERVICES, P.C.
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGY & PSYCHOLOGY SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SANTA MARIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:716-690-2560
Mailing Address - Street 1:445 TREMONT ST
Mailing Address - Street 2:SUITE 323
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-6150
Mailing Address - Country:US
Mailing Address - Phone:716-690-2560
Mailing Address - Fax:716-690-2585
Practice Address - Street 1:445 TREMONT ST
Practice Address - Street 2:SUITE 323
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-6150
Practice Address - Country:US
Practice Address - Phone:716-690-2560
Practice Address - Fax:716-690-2585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014396103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02186592Medicaid
NYAA1668Medicare PIN