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General NPI Number Information
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NPI Number | 1932566882
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE NEUROBEHAVIORAL SERVICES, P.A.
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Dates
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Enumeration Date | 01/23/2016
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Last Update Date | 01/23/2016
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Provider Practice Location Address
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Address Line | 2142 ALT 19 STE C1
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City | PALM HARBOR
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State | FL
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Zip | 34683-5361
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Country | US
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Telephone | 916-716-9105
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Fax |
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Provider Business Mailing Address
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Address Line | 2142 ALT 19 STE C1
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City | PALM HARBOR
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State | FL
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Zip | 34683-5361
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHANNON MARIE FOSTER
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Credential | PH.D.
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Telephone | 916-716-9105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | PY 9339
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 9339
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY 9339
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License Number State | FL
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