Provider Demographics
NPI:1194233866
Name:MK NEUROPSYCHOLOGY SERVICES, PC
Entity type:Organization
Organization Name:MK NEUROPSYCHOLOGY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINETSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:916-672-1427
Mailing Address - Street 1:6520 LONETREE BLVD STE 1021
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5874
Mailing Address - Country:US
Mailing Address - Phone:916-672-1427
Mailing Address - Fax:
Practice Address - Street 1:6520 LONETREE BLVD STE 1021
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5874
Practice Address - Country:US
Practice Address - Phone:916-672-1427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty