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General NPI Number Information
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NPI Number | 1861636045
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Entity Type | Organization
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Legal Business Name | UNIVERSITY NEUROPSYCHOLOGY, INC.
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Dates
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Enumeration Date | 05/01/2009
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 364 HARVARD ST SUITE 1
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City | BROOKLINE
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State | MA
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Zip | 02446-2920
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Country | US
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Telephone | 617-877-5978
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Fax | 206-666-3687
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Provider Business Mailing Address
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Address Line | 491 DUTTON ST #304
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City | LOWELL
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State | MA
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Zip | 01854-4289
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Country | US
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Telephone | 617-877-5978
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Fax | 206-666-3687
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Authorized Official
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Title or Position | PRESIDENT
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Name | MILES TARTER
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Credential | PSY.D.
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Telephone | 617-877-5978
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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 | 8703
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License Number State | MA
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