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General NPI Number Information
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NPI Number | 1366733966
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Entity Type | Organization
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Legal Business Name | CENTER FOR ADVANCED NEUROPSYCHOLOGY, LLC
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Dates
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Enumeration Date | 04/29/2011
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 7171 N UNIVERSITY DR STE 300
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City | TAMARAC
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State | FL
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Zip | 33321-2902
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Country | US
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Telephone | 954-586-0624
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26761
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City | TAMARAC
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State | FL
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Zip | 33320-6761
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Country | US
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Telephone | 954-586-0624
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NORMA MARIA KOWALSKI
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Credential | PSY.D
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Telephone | 954-586-0624
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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 | PY8258
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License Number State | FL
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