Basic Information
| Provider Information | |||||||||
| NPI: | 1881815660 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUROBEHAVIORAL ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2257 | ||||||||
| Address2: | |||||||||
| City: | CHESTERTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463040357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199268320 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2033 MILWAUKEE AVE | ||||||||
| Address2: | SUITE 334 | ||||||||
| City: | RIVERWOODS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600153581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035200489 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | REA | ||||||||
| AuthorizedOfficialFirstName: | JACQUELINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR CLINICAL MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3035200489 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103G00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.