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General NPI Number Information
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NPI Number | 1568854727
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Entity Type | Organization
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Legal Business Name | NORTH BAY NEUROPSYCHOLOGY A PSYCHOLOGY CORPORATION
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 1221 FARMERS LN STE C
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City | SANTA ROSA
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State | CA
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Zip | 95405-6712
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Country | US
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Telephone | 707-829-5057
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Fax | 707-829-5084
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Provider Business Mailing Address
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Address Line | 1221 FARMERS LN STE C
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City | SANTA ROSA
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State | CA
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Zip | 95405-6712
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Country | US
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Telephone | 707-829-5057
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Fax | 707-829-5084
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELLEN O'TOOLE
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Credential | PH.D.
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Telephone | 707-829-5057
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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 | 22201
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 22201
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 22201
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License Number State | CA
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