Provider Demographics
NPI:1902329667
Name:NEUROPERFORMANCE GROUP, L.L.C
Entity Type:Organization
Organization Name:NEUROPERFORMANCE GROUP, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:917-402-2880
Mailing Address - Street 1:TWO REGENCY PLAZA
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903
Mailing Address - Country:US
Mailing Address - Phone:401-484-1706
Mailing Address - Fax:401-437-6959
Practice Address - Street 1:TWO REGENCY PLAZA
Practice Address - Street 2:SUITE 3
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-484-1706
Practice Address - Fax:401-437-6959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty