MEDICARE: NEUROPSYCHOLOGICAL ASSOCIATES OF SOUTH FLORIDA PA

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	103TC0700X	Clinical Psychologist	PY 6116	FL

General Provider Information

NPI Number	:	1881613743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROPSYCHOLOGICAL ASSOCIATES OF SOUTH FLORIDA PA

Provider Business Mailing Address
First Line	:	12600 CREEKSIDE LN STE 7A
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3353
Country	:	US
Telephone Number	:	239-481-1633
Fax Number	:	293-481-1632

Provider Business Practice Location Address
First Line	:	12600 CREEKSIDE LN STE 7A
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3353
Country	:	US
Telephone Number	:	239-481-1633
Fax Number	:	293-481-1632

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST NEUROPSYCHOL
Name	:	DR. STEPHEN PATRICK SCHENGBER
Credential	:	PSY D
Telephone Number	:	239-481-1633

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	09/20/2007

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