Healthcare Provider Details

I. General information

NPI: 1932566882
Provider Name (Legal Business Name): COMPREHENSIVE NEUROBEHAVIORAL SERVICES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2016
Last Update Date: 01/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 ALT 19 STE C1
PALM HARBOR FL
34683-5361
US

IV. Provider business mailing address

2142 ALT 19 STE C1
PALM HARBOR FL
34683-5361
US

V. Phone/Fax

Practice location:
  • Phone: 916-716-9105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPY 9339
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 9339
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY 9339
License Number StateFL

VIII. Authorized Official

Name: SHANNON MARIE FOSTER
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 916-716-9105