MEDICARE: DR. PHILIP A NORFOLK PHD, BCBA

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	103TB0200X	Cognitive & Behavioral Psychologist
2	103T00000X	Psychologist	3543	TN
3	103TC2200X	Clinical Child & Adolescent Psychologist
4	103TM1800X	Intellectual & Developmental Disabilities Psychologist
5	103K00000X	Behavior Analyst	1-18-31686

General Provider Information

NPI Number	:	1659831451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP A NORFOLK PHD, BCBA

Provider Business Mailing Address
First Line	:	801 NW VESPER ST
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-3733
Country	:	US
Telephone Number	:	816-200-0207
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 NW VESPER ST
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-3733
Country	:	US
Telephone Number	:	816-200-0207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	12/09/2025

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