MEDICARE: CAPE NEUROPSYCHOLOGY LLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1710669361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE NEUROPSYCHOLOGY LLC

Provider Business Mailing Address
First Line	:	23 GRAND AVE
Second Line	:
City	:	ATLANTIC HIGHLANDS
State	:	NJ
Zip	:	07716-1347
Country	:	US
Telephone Number	:	858-204-1717
Fax Number	:	973-799-9283

Provider Business Practice Location Address
First Line	:	23 GRAND AVE
Second Line	:
City	:	ATLANTIC HIGHLANDS
State	:	NJ
Zip	:	07716-1347
Country	:	US
Telephone Number	:	858-204-1717
Fax Number	:	973-799-9283

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MICHELLE EOFF
Credential	:
Telephone Number	:	551-258-3605

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	10/09/2023

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