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General NPI Number Information
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NPI Number | 1508004540
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Entity Type | Organization
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Legal Business Name | NEUROPSYCHOLOGICAL ASSOC OF CA-A PROFESSIONAL PSYCHOLOGICAL CORP
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Dates
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Enumeration Date | 01/29/2009
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Last Update Date | 11/15/2019
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Provider Practice Location Address
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Address Line | 1260 N DUTTON AVE STE 225
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City | SANTA ROSA
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State | CA
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Zip | 95401-4659
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Country | US
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Telephone | 707-526-5424
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Fax | 707-526-5900
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Provider Business Mailing Address
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Address Line | 1260 N DUTTON AVE STE 225
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City | SANTA ROSA
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State | CA
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Zip | 95401-4659
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Country | US
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Telephone | 707-526-5424
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Fax | 707-526-5900
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. CAROLYN FRANCES CRIMMINS
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Credential | PSY.D.
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Telephone | 707-526-5424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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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 | 23205
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License Number State | CA
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