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General NPI Number Information
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NPI Number | 1316149362
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Entity Type | Organization
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Legal Business Name | BORGARO NEUROPSYCHOLOGY SERVICES, LLC
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 300 W CLARENDON SUITE 130
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City | PHOENIX
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State | AZ
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Zip | 85013-3421
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Country | US
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Telephone | 602-300-1508
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Fax | 602-277-5848
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Provider Business Mailing Address
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Address Line | 11445 E VIA LINDA SUITE 2, PMB 473
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-2654
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Country | US
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Telephone | 602-300-1508
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Fax | 602-277-5848
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Authorized Official
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Title or Position | DIRECTOR
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Name | SUSAN BORGARO
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Credential | PHD
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Telephone | 602-300-1508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3457
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License Number State | NJ
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