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General NPI Number Information
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NPI Number | 1730227745
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Entity Type | Organization
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Legal Business Name | PEDIATRIC NEUROPSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 7 GARAGE RD UNIT D
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City | SOUTHBURY
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State | CT
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Zip | 06488-3884
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Country | US
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Telephone | 203-262-4482
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Fax |
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Provider Business Mailing Address
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Address Line | 7 GARAGE RD UNIT D
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City | SOUTHBURY
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State | CT
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Zip | 06488-3884
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Country | US
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Telephone | 203-262-4482
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. RICHARD H GRAYSON
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Credential | PH.D.
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Telephone | 203-262-4482
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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 | 015711-1
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License Number State | NY
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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 | 002567
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License Number State | CT
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