Provider Demographics
NPI:1780868422
Name:KEENE NEUROPSYCHOLOGY CLINIC PLLC
Entity type:Organization
Organization Name:KEENE NEUROPSYCHOLOGY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER, NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:603-357-8378
Mailing Address - Street 1:103 ROXBURY ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-8801
Mailing Address - Country:US
Mailing Address - Phone:603-357-8378
Mailing Address - Fax:603-357-8375
Practice Address - Street 1:103 ROXBURY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-8801
Practice Address - Country:US
Practice Address - Phone:603-357-8378
Practice Address - Fax:603-357-8375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1034103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015110Medicaid
NH0003807Medicare PIN