Provider Demographics
NPI:1013350768
Name:NEURO-PSYCHOLOGY PRACTICE PLLC
Entity Type:Organization
Organization Name:NEURO-PSYCHOLOGY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:COUVADELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:800-240-1038
Mailing Address - Street 1:417 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3491
Mailing Address - Country:US
Mailing Address - Phone:469-693-2757
Mailing Address - Fax:888-770-4153
Practice Address - Street 1:5030 BROADWAY
Practice Address - Street 2:SUITE 809
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1609
Practice Address - Country:US
Practice Address - Phone:800-240-1038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019337-1103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty