Provider Demographics
NPI:1881947745
Name:NEUROPSYCHOLOGY AND CONCUSSION MANAGEMENT ASSOCIATES LLC
Entity type:Organization
Organization Name:NEUROPSYCHOLOGY AND CONCUSSION MANAGEMENT ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPP-CN
Authorized Official - Phone:207-594-2952
Mailing Address - Street 1:PO BOX 1084
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-1084
Mailing Address - Country:US
Mailing Address - Phone:207-594-2952
Mailing Address - Fax:888-714-5185
Practice Address - Street 1:120 TILLSON AVE
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3451
Practice Address - Country:US
Practice Address - Phone:207-594-2952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1009103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8448Medicare PIN