Healthcare Provider Details

I. General information

NPI: 1053744201
Provider Name (Legal Business Name): AAA NEUROPSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LINDENWOOD DR SUITE 225
MALVERN PA
19355-1755
US

IV. Provider business mailing address

101 LINDENWOOD DR SUITE 225
MALVERN PA
19355-1755
US

V. Phone/Fax

Practice location:
  • Phone: 484-870-5608
  • Fax:
Mailing address:
  • Phone: 484-870-5608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS017067
License Number StatePA

VIII. Authorized Official

Name: FARZIN IRANI
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 484-870-5608