MEDICARE: NEUROPSYCHOLOGICAL SERVICES

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	251S00000X	Community/Behavioral Health Agency	013297	NY

General Provider Information

NPI Number	:	1710194287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROPSYCHOLOGICAL SERVICES

Provider Business Mailing Address
First Line	:	39 COURT ST
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-2801
Country	:	US
Telephone Number	:	518-563-6658
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 PINE RIDGE DR
Second Line	:
City	:	MORRISONVILLE
State	:	NY
Zip	:	12962-9797
Country	:	US
Telephone Number	:	518-536-0330
Fax Number	:	518-563-1633

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. JEANNE PAULA RYAN
Credential	:	PH.D.
Telephone Number	:	518-536-0330

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	10/10/2014

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