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General NPI Number Information
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NPI Number | 1205110822
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Entity Type | Organization
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Legal Business Name | NORTH SHORE NEUROPSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 09/30/2011
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 5 ESSEX GREEN DRIVE SUITE 23
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City | PEABODY
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State | MA
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Zip | 01960
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Country | US
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Telephone | 857-383-0651
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Fax | 781-990-3722
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Provider Business Mailing Address
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Address Line | 5 ESSEX GREEN DRIVE SUITE 23
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City | PEABODY
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State | MA
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Zip | 01960
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Country | US
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Telephone | 857-383-0651
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Fax | 781-990-3722
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Authorized Official
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Title or Position | CLINICAL NEUROPSYCHOLOGIST
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Name | DR. COURTNEY LOBRAICO
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Credential | PSYD
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Telephone | 857-383-0651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 8883
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License Number State | MA
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