Provider Demographics
NPI:1396903563
Name:AUDUBON PSYCHOLOGICAL SERVICES L.L.C.
Entity type:Organization
Organization Name:AUDUBON PSYCHOLOGICAL SERVICES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:MILES
Authorized Official - Last Name:NEUBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-546-3040
Mailing Address - Street 1:1101 KINGS HWY N STE 303
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1912
Mailing Address - Country:US
Mailing Address - Phone:856-546-3040
Mailing Address - Fax:856-616-1172
Practice Address - Street 1:1101 N. KINGS HIGHWAY
Practice Address - Street 2:SUITE 303
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3214
Practice Address - Country:US
Practice Address - Phone:856-546-3040
Practice Address - Fax:856-667-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4276103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty