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General NPI Number Information
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NPI Number | 1487069241
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Entity Type | Organization
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Legal Business Name | SHORELINE NEUROPSYCHOLOGY AND BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 173 MONTOWESE ST
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City | BRANFORD
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State | CT
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Zip | 06405-3887
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Country | US
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Telephone | 475-221-8108
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Fax |
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Provider Business Mailing Address
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Address Line | 173 MONTOWESE ST
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City | BRANFORD
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State | CT
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Zip | 06405-3887
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Country | US
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Telephone | 475-221-8108
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Fax |
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST
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Name | AMY PALMER
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Credential | PSYD
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Telephone | 475-221-8108
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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 | 2416
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License Number State | CT
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