=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497330740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R&M NEUROPSYCHOLOGY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2021
-----------------------------------------------------
Last Update Date | 03/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 MAXWELL DR STE 205
-----------------------------------------------------
City | CLIFTON PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12065-2933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-288-7156
-----------------------------------------------------
Fax | 518-309-7838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 MAXWELL DR STE 205
-----------------------------------------------------
City | CLIFTON PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12065-2933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-288-7156
-----------------------------------------------------
Fax | 518-309-7838
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NEUROPSYCHOLOGIST/OWNER
-----------------------------------------------------
Name | REBECCA MARTIN
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 518-288-7156
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------