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General NPI Number Information
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NPI Number | 1700384013
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Entity Type | Organization
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Legal Business Name | QUEENS NEUROPSYCHOLOGICAL AND BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 02/22/2018
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Provider Practice Location Address
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Address Line | 25418 NORTHERN BLVD STE 3
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City | LITTLE NECK
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State | NY
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Zip | 11362-1451
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Country | US
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Telephone | 646-389-2283
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Fax |
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Provider Business Mailing Address
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Address Line | 25418 NORTHERN BLVD STE 3
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City | LITTLE NECK
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State | NY
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Zip | 11362-1451
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Country | US
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Telephone | 646-389-2283
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ELSA LEE
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Credential | PH.D.
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Telephone | 646-389-2283
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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 | 022457
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 022457
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 022457
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 022457
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License Number State | NY
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