Organization
NEUROPSYCHOLOGY & MEMORY CENTER, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODY E. TALBOTT PH.D. (OWNER PRESIDENT)
(239) 592-1771
Entity
Organization
Contact information
Practice address
4521 EXECUTIVE DR, SUITE # 204, NAPLES, FL 34119-9037
(239) 592-1771
(239) 592-0258
Mailing address
4521 EXECUTIVE DR, SUITE # 204, NAPLES, FL 34119-9037
(239) 592-1771
(239) 592-0258
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY 7020
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U4063Y
MEDICARE PTAN
FL
Enumeration date
07/12/2006
Last updated
05/19/2011
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