Provider Demographics
NPI:1861898140
Name:NEKORANEC PSYCHOLOGY, A PROF CORP
Entity type:Organization
Organization Name:NEKORANEC PSYCHOLOGY, A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NEKORANEC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-371-7856
Mailing Address - Street 1:30230 RANCHO VIEJO RD # 134
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1557
Mailing Address - Country:US
Mailing Address - Phone:949-371-7856
Mailing Address - Fax:
Practice Address - Street 1:30230 RANCHO VIEJO RD # 134
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1557
Practice Address - Country:US
Practice Address - Phone:949-371-7856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGY831AOtherMEDICARE PTAN
CA1831439652OtherNPPES