| Lifespan Neuropsychology And Counseling Center, Llc | |
|
2060 Oak Tree Rd 3rd Floor Edison NJ 08820 | |
| (908) 472-1255 | |
| (848) 200-7713 |
| Full Name | Lifespan Neuropsychology And Counseling Center, Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 2060 Oak Tree Rd, Edison, New Jersey |
| Authorized Official Name and Position | Georgianna Dart (OWNER) |
| Authorized Official Contact | 9084721255 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifespan Neuropsychology And Counseling Center, Llc 2060 Oak Tree Rd 3rd Floor Edison NJ 08820 Ph: (908) 472-1255 | Lifespan Neuropsychology And Counseling Center, Llc 2060 Oak Tree Rd 3rd Floor Edison NJ 08820 Ph: (908) 472-1255 |
| NPI Number | 1689181638 |
|---|---|
| Provider Enumeration Date | 12/29/2017 |
| Last Update Date | 11/27/2019 |
| Medicare PECOS PAC ID | 3971865783 |
|---|---|
| Medicare Enrollment ID | O20180314001843 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689181638 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 4987 (New Jersey) | Primary |
| Provider Name | Georgianna Dart |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750644324 PECOS PAC ID: 8820241136 Enrollment ID: I20130118000208 |
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