Provider Demographics
NPI:1730688920
Name:FAIRFIELD NEUROPSYCHOLOGY LLC
Entity type:Organization
Organization Name:FAIRFIELD NEUROPSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-292-6886
Mailing Address - Street 1:60 THORPE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5725
Mailing Address - Country:US
Mailing Address - Phone:203-292-6886
Mailing Address - Fax:203-212-9242
Practice Address - Street 1:60 THORPE ST FL 2
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5725
Practice Address - Country:US
Practice Address - Phone:203-292-6886
Practice Address - Fax:203-212-9242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002167103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty