Provider Demographics
NPI:1265764278
Name:NEUROPSYCHOLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:NEUROPSYCHOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESICENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:6022-308-3224
Mailing Address - Street 1:6232 N 7TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1839
Mailing Address - Country:US
Mailing Address - Phone:602-230-8324
Mailing Address - Fax:602-274-7402
Practice Address - Street 1:141 S MCCORMICK ST
Practice Address - Street 2:SUITE 109
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4729
Practice Address - Country:US
Practice Address - Phone:928-777-2477
Practice Address - Fax:602-274-7402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROPSYCHOLOGY ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ689103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ27056Medicare PIN