Healthcare Provider Details

I. General information

NPI: 1205948262
Provider Name (Legal Business Name): NEUROPSYCHOLOGY CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 38TH ST SUITE 421
AUSTIN TX
78731-6400
US

IV. Provider business mailing address

1600 W 38TH ST SUITE 421
AUSTIN TX
78731-6400
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-9429
  • Fax:
Mailing address:
  • Phone: 512-454-9429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number24575
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number24575
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number24575
License Number StateTX

VIII. Authorized Official

Name: DR. LESLIE DEE ROSENSTEIN
Title or Position: PRESIDENT/OWNER
Credential: PH.D.
Phone: 512-454-9429