Healthcare Provider Details

I. General information

NPI: 1881815660
Provider Name (Legal Business Name): NEUROBEHAVIORAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 MILWAUKEE AVE SUITE 334
RIVERWOODS IL
60015-3581
US

IV. Provider business mailing address

PO BOX 2257
CHESTERTON IN
46304-0357
US

V. Phone/Fax

Practice location:
  • Phone: 303-520-0489
  • Fax:
Mailing address:
  • Phone: 219-926-8320
  • 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 Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JACQUELINE REA
Title or Position: SENIOR CLINICAL MANAGER
Credential:
Phone: 303-520-0489