MEDICARE: NEUROBEHAVIORAL PROGRAMS, INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY12821	CA

General Provider Information

NPI Number	:	1548541873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROBEHAVIORAL PROGRAMS, INCORPORATED

Provider Business Mailing Address
First Line	:	2659 PORTAGE BAY E APT 204
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-3050
Country	:	US
Telephone Number	:	707-688-8956
Fax Number	:	415-663-8985

Provider Business Practice Location Address
First Line	:	2659 PORTAGE BAY E APT 204
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-3050
Country	:	US
Telephone Number	:	707-688-8956
Fax Number	:	415-663-8985

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN EDMUND LEONARD
Credential	:	PH.D.
Telephone Number	:	707-688-8956

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	08/31/2011

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