Provider Demographics
NPI:1205137056
Name:NEUROPSYCHOLOGY SERVICES, PC
Entity type:Organization
Organization Name:NEUROPSYCHOLOGY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:DECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:508-393-3820
Mailing Address - Street 1:PO BOX 605
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-0605
Mailing Address - Country:US
Mailing Address - Phone:508-393-3820
Mailing Address - Fax:508-393-3814
Practice Address - Street 1:96 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-3810
Practice Address - Country:US
Practice Address - Phone:508-393-3820
Practice Address - Fax:508-393-3814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8183261QM0855X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0522791Medicaid
MAW51465Medicare PIN
MAR08598Medicare UPIN