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General NPI Number Information
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NPI Number | 1104348283
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE NEUROPSYCHOLOGY SERVICES PC
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 99 MADISON AVE FL 5
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City | NEW YORK
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State | NY
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Zip | 10016-7419
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Country | US
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Telephone | 917-740-8195
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Fax |
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Provider Business Mailing Address
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Address Line | 880 W 181ST ST APT 5A
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City | NEW YORK
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State | NY
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Zip | 10033-4474
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Country | US
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Telephone | 917-740-8195
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/SOLE OWNER
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Name | LUBA NAKHUTINA
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Credential | PHD
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Telephone | 917-740-8195
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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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