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General NPI Number Information
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NPI Number | 1871070052
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Entity Type | Organization
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Legal Business Name | NEW CONNECTIONS NEUROPSYCHOLOGY, PC
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 07/22/2018
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Provider Practice Location Address
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Address Line | 1057 MACARTHUR BLVD STE 214
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City | SAN LEANDRO
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State | CA
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Zip | 94577
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Country | US
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Telephone | 510-944-0221
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Fax |
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Provider Business Mailing Address
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Address Line | 1057 MACARTHUR BLVD STE 214
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City | SAN LEANDRO
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State | CA
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Zip | 94577-3000
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Country | US
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Telephone | 510-944-0221
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARYANN KRUSE BENS
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Credential | PSYD
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Telephone | 510-944-0221
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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 | PSY29300
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY29300
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | PSY29300
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License Number State | CA
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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 | PSY29300
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License Number State | CA
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