Provider Demographics
NPI:1487795266
Name:NEUROPSYCHOLOGICAL & EDUCATIONAL SERVICES
Entity type:Organization
Organization Name:NEUROPSYCHOLOGICAL & EDUCATIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERNEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:401-521-0034
Mailing Address - Street 1:295 ANGELL ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2119
Mailing Address - Country:US
Mailing Address - Phone:401-521-0034
Mailing Address - Fax:401-521-0035
Practice Address - Street 1:295 ANGELL ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2119
Practice Address - Country:US
Practice Address - Phone:401-521-0034
Practice Address - Fax:401-521-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00805103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI241894Medicare UPIN
RI00410415Medicare UPIN