Organization
CLINICAL NEUROPSYCHOLOGY ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD MAITZ PHD (TREASURER)
(215) 735-2505
Entity
Organization
Contact information
Practice address
1528 WALNUT ST, SUITE 1500, PHILADELPHIA, PA 19102-3604
(215) 735-2505
(215) 735-2504
Mailing address
PO BOX 359, FURLONG, PA 18925-0359
(215) 735-2505
(215) 735-2504
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
004599L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1687168
PA BLUE SHIELD GROUP NUMB
PA
Enumeration date
01/31/2007
Last updated
10/05/2010
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