Healthcare Provider Details

I. General information

NPI: 1508004540
Provider Name (Legal Business Name): NEUROPSYCHOLOGICAL ASSOC OF CA-A PROFESSIONAL PSYCHOLOGICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 N DUTTON AVE STE 225
SANTA ROSA CA
95401-4659
US

IV. Provider business mailing address

1260 N DUTTON AVE STE 225
SANTA ROSA CA
95401-4659
US

V. Phone/Fax

Practice location:
  • Phone: 707-526-5424
  • Fax: 707-526-5900
Mailing address:
  • Phone: 707-526-5424
  • Fax: 707-526-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number23205
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROLYN FRANCES CRIMMINS
Title or Position: PROVIDER
Credential: PSY.D.
Phone: 707-526-5424