Basic Information
| Provider Information | |||||||||
| NPI: | 1730800194 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE CENTER FOR NEUROLOGICAL AND NEURODEVELOPMENTAL HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2050 VOORHEES TOWN CTR | ||||||||
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| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080431910 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 2050 VOORHEES TOWN CTR | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080431910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563460005 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2022 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | CLEMONS | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2159854448 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 193200000X MULTI-SPECIALTY GROUP | 2084B0040X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | 103K00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.