Provider Demographics
NPI:1134979644
Name:GANESHA INSTITUTE OF NEUROLOGY AND PSYCHIATRY SC
Entity type:Organization
Organization Name:GANESHA INSTITUTE OF NEUROLOGY AND PSYCHIATRY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-816-6441
Mailing Address - Street 1:PO BOX 14545
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4038
Mailing Address - Country:US
Mailing Address - Phone:847-816-6335
Mailing Address - Fax:
Practice Address - Street 1:9327 N 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2473
Practice Address - Country:US
Practice Address - Phone:847-816-6335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GANESHA INSTITUTE OF NEUROLOGY AND PSYCHIATRY SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-26
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty