Provider Demographics
NPI:1801172192
Name:STRATEGIC NEUROPSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:STRATEGIC NEUROPSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:SACKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-344-1999
Mailing Address - Street 1:40 WATERSIDE PLZ
Mailing Address - Street 2:APT 12L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2631
Mailing Address - Country:US
Mailing Address - Phone:917-340-1612
Mailing Address - Fax:
Practice Address - Street 1:1651 3RD AVE
Practice Address - Street 2:RM 201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3679
Practice Address - Country:US
Practice Address - Phone:201-344-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty