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General NPI Number Information
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NPI Number | 1215970041
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Entity Type | Organization
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Legal Business Name | THE NEUROBEHAVIORAL GROUP, A PSYCHOLOGICAL CORPORATION
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1400 N HARBOR BLVD SUITE 440
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City | FULLERTON
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State | CA
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Zip | 92835-4126
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Country | US
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Telephone | 714-681-9070
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Fax | 714-773-4788
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Provider Business Mailing Address
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Address Line | 1400 N HARBOR BLVD SUITE 440
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City | FULLERTON
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State | CA
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Zip | 92835-4126
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Country | US
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Telephone | 714-681-9070
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Fax | 714-773-4788
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Authorized Official
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Title or Position | CFO
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Name | DR. EILEEN SWAN KANG
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Credential | PH.D.
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Telephone | 714-681-9070
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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 |
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License Number State |
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