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General NPI Number Information
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NPI Number | 1316245632
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Entity Type | Organization
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Legal Business Name | NORTHEAST PSYCHOLOGICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 578 GEIGER DR SUITE A-1
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City | ROANOKE
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State | IN
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Zip | 46783-8872
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Country | US
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Telephone | 260-676-2252
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Fax | 260-676-2260
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Provider Business Mailing Address
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Address Line | 578 GEIGER DR SUITE A-1
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City | ROANOKE
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State | IN
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Zip | 46783-8872
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Country | US
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Telephone | 260-676-2252
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Fax | 260-676-2260
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. PAULA A NEUMAN
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Credential | ED.D, PSY.D,, HSPP
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Telephone | 260-676-2252
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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 | 20042473A
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License Number State | IN
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