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General NPI Number Information
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NPI Number | 1689181638
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Entity Type | Organization
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Legal Business Name | LIFESPAN NEUROPSYCHOLOGY AND COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 12/29/2017
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Last Update Date | 11/27/2019
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Provider Practice Location Address
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Address Line | 2060 OAK TREE RD 3RD FLOOR
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City | EDISON
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State | NJ
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Zip | 08820
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Country | US
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Telephone | 908-472-1255
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Fax | 848-200-7713
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Provider Business Mailing Address
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Address Line | 2060 OAK TREE RD 3RD FLOOR
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City | EDISON
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State | NJ
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Zip | 08820
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Country | US
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Telephone | 908-472-1255
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Fax | 848-200-7713
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGIANNA DART
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Credential | PSY.D.
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Telephone | 908-472-1255
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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 | 4987
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License Number State | NJ
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