Organization
CORNERSTONE NEUROPSYCHOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDI NICHOLS MCDONALD PSY.D. (OWNER)
(850) 613-6677
Entity
Organization
Contact information
Practice address
1270 EGLIN PKWY, SUITE C-12, SHALIMAR, FL 32579-2306
(850) 613-6677
(850) 613-6993
Mailing address
1270 EGLIN PKWY, SUITE C-12, SHALIMAR, FL 32579-2306
(850) 613-6677
(850) 613-6993
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PY7940
FL
103T00000X
Psychologist
PY7940
FL
103TB0200X
Cognitive & Behavioral Psychologist
PY7940
FL
103TC0700X
Clinical Psychologist
Primary
PY7940
FL
103TF0200X
Forensic Psychologist
PY7940
FL
103TM1800X
Intellectual & Developmental Disabilities Psychologist
PY7940
FL
Other
Enumeration date
05/09/2013
Last updated
05/09/2013
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