MEDICARE: DR CLOYD'S CLINICAL PSYCHOLOGY AND NEUROPSYCHOLOGY PRACTICE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1215563887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR CLOYD'S CLINICAL PSYCHOLOGY AND NEUROPSYCHOLOGY PRACTICE PLLC

Provider Business Mailing Address
First Line	:	529 KINGSLEY CT
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2719
Country	:	US
Telephone Number	:	215-990-7714
Fax Number	:	856-428-4050

Provider Business Practice Location Address
First Line	:	1209 ROUTE 70 W
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08002-3532
Country	:	US
Telephone Number	:	215-990-7714
Fax Number	:	856-428-4050

Authorized Official
Title or Position	:	CLINICAL/NEURO PSCHOLOGIST/MANAGER/
Name	:	CARTER JOSEPH CLOYD
Credential	:	PSY.D
Telephone Number	:	215-990-7714

Provider Enumeration Date	:	03/16/2020
Last Update Date	:	03/16/2020

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