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General NPI Number Information
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NPI Number | 1487736120
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Entity Type | Individual
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Provider Name | KEREN LITAL ISAACS LEBEAU PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 99 BEAUVOIR AVE 5TH FLOOR
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City | SUMMIT
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State | NJ
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Zip | 07901-3533
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Country | US
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Telephone | 908-522-5643
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Fax |
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Provider Business Mailing Address
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Address Line | 104 E 40TH ST SUITE 607
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City | NEW YORK
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State | NY
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Zip | 10016-1801
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Country | US
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Telephone | 212-661-7460
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 35SI00435400
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License Number State | NJ
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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 | 68 016217
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License Number State | NY
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