Organization
NEUROPSYCHOLOGY SERVICE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROYAL G GRUENEICH PHD (PRESIDENT)
(207) 990-2580
Entity
Organization
Contact information
Practice address
277 STATE STREET, SUITE 2A, BANGOR, ME 04401-5440
(207) 990-2580
(207) 990-1930
Mailing address
277 STATE ST, SUITE 2A, BANGOR, ME 04401-5439
(207) 990-2580
(207) 990-1930
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5418635
AETNA
—
01
—
P0724
ANTHEM
—
Enumeration date
05/07/2007
Last updated
12/02/2010
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