Provider Demographics
NPI:1952068934
Name:DR.KHANALI'S NEUROPSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:DR.KHANALI'S NEUROPSYCHOLOGICAL SERVICES, LLC
Other - Org Name:DR.KHANALI'S NEUROPSYCHOLOGICAL SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-317-1386
Mailing Address - Street 1:1320 CENTRAL PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4953
Mailing Address - Country:US
Mailing Address - Phone:571-317-1386
Mailing Address - Fax:
Practice Address - Street 1:1320 CENTRAL PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4953
Practice Address - Country:US
Practice Address - Phone:571-317-1386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty