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General NPI Number Information
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NPI Number | 1043814874
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Entity Type | Organization
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Legal Business Name | THE NEUROPSYCHOLOGY CENTER OF ST. LOUIS
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 425 N NEW BALLAS RD STE 290
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City | CREVE COEUR
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State | MO
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Zip | 63141-6852
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Country | US
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Telephone | 314-324-3800
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Fax | 314-260-7676
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Provider Business Mailing Address
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Address Line | 425 N NEW BALLAS RD STE 290
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City | CREVE COEUR
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State | MO
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Zip | 63141-6852
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Country | US
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Telephone | 314-324-3800
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Fax | 314-260-7676
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST/MEMBER
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Name | DR. TAMMY A MARTIELLI
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Credential | PH.D.
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Telephone | 314-324-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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