Provider Demographics
NPI:1700916137
Name:CLINICAL NEUROSCIENCE RESEARCH ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CLINICAL NEUROSCIENCE RESEARCH ASSOCIATES, INC.
Other - Org Name:THE MEMORY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MBA
Authorized Official - Phone:802-447-1409
Mailing Address - Street 1:357 SHIELDS DR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-9810
Mailing Address - Country:US
Mailing Address - Phone:802-447-1409
Mailing Address - Fax:802-442-5199
Practice Address - Street 1:357 SHIELDS DR
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-9810
Practice Address - Country:US
Practice Address - Phone:802-447-1409
Practice Address - Fax:802-442-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN1754Medicare PIN
VN1754Medicare PIN