Healthcare Provider Details

I. General information

NPI: 1194233866
Provider Name (Legal Business Name): MK NEUROPSYCHOLOGY SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 LONETREE BLVD STE 1021
ROCKLIN CA
95765-5874
US

IV. Provider business mailing address

6520 LONETREE BLVD STE 1021
ROCKLIN CA
95765-5874
US

V. Phone/Fax

Practice location:
  • Phone: 916-672-1427
  • Fax:
Mailing address:
  • Phone: 916-672-1427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MARINA KAMINETSKAYA
Title or Position: NEUROPSYCHOLOGIST/PRESIDENT
Credential: PH.D.
Phone: 916-672-1427