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General NPI Number Information
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NPI Number | 1396991956
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Entity Type | Organization
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Legal Business Name | NORTHEAST NEUROPSYCHOLOGY, LLC
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 609 W JOHNSON AVE STE 104
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City | CHESHIRE
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State | CT
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Zip | 06410-4506
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Country | US
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Telephone | 203-272-6007
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Fax | 203-272-8895
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Provider Business Mailing Address
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Address Line | 609 W JOHNSON AVE STE 104
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City | CHESHIRE
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State | CT
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Zip | 06410-4506
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Country | US
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Telephone | 203-272-6007
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Fax | 203-272-8895
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Authorized Official
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Title or Position | CEO
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Name | LYNN HAMILTON
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Credential |
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Telephone | 888-344-3893
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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 | 002847
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 002206
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 001864
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License Number State | CT
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