MEDICARE: NORFOLK NEURODIVERSE EVALUATIONS & SUPPORT, LLC

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1932072717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORFOLK NEURODIVERSE EVALUATIONS & SUPPORT, LLC

Provider Business Mailing Address
First Line	:	2007 NE NEWPORT CT
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-1810
Country	:	US
Telephone Number	:
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	:	816-326-9023

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	PHILIP NORFOLK
Credential	:	PHD
Telephone Number	:	901-359-4481

Provider Enumeration Date	:	09/26/2025
Last Update Date	:	11/12/2025

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