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General NPI Number Information
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NPI Number | 1760900831
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Entity Type | Organization
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Legal Business Name | K&M NEUROPSYCHOLOGY, A PSYCHOLOGY CORPORATION
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Dates
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Enumeration Date | 09/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 100 SHORELINE HWY STE 100
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City | MILL VALLEY
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State | CA
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Zip | 94941-3645
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Country | US
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Telephone | 415-877-4408
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Fax |
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Provider Business Mailing Address
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Address Line | 100 SHORELINE HWY BLDG B, SUITE 100
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City | MILL VALLEY
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State | CA
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Zip | 94941
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Country | US
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Telephone | 415-877-4408
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Fax |
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST
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Name | DR. THOMAS KIELY
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Credential | PH.D.
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Telephone | 650-455-9514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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