Provider Demographics
NPI:1366792202
Name:METROWEST NEUROPSYCHOLOGY, LLC
Entity type:Organization
Organization Name:METROWEST NEUROPSYCHOLOGY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:508-983-1425
Mailing Address - Street 1:1900 W PARK DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3942
Mailing Address - Country:US
Mailing Address - Phone:508-983-1425
Mailing Address - Fax:508-983-0987
Practice Address - Street 1:1900 W PARK DR
Practice Address - Street 2:SUITE 280
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3942
Practice Address - Country:US
Practice Address - Phone:508-983-1425
Practice Address - Fax:508-983-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty