MEDICARE: NEUROBEHAVIORAL ASSOCIATES, P.C.

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
2	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1881815660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROBEHAVIORAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 2257
Second Line	:
City	:	CHESTERTON
State	:	IN
Zip	:	46304-0357
Country	:	US
Telephone Number	:	219-926-8320
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 MILWAUKEE AVE
Second Line	:	SUITE 334
City	:	RIVERWOODS
State	:	IL
Zip	:	60015-3581
Country	:	US
Telephone Number	:	303-520-0489
Fax Number	:

Authorized Official
Title or Position	:	SENIOR CLINICAL MANAGER
Name	:	DR. JACQUELINE REA
Credential	:
Telephone Number	:	303-520-0489

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	04/01/2021

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