Provider Demographics
NPI:1215970041
Name:THE NEUROBEHAVIORAL GROUP, A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:THE NEUROBEHAVIORAL GROUP, A PSYCHOLOGICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:SWAN
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-681-9070
Mailing Address - Street 1:1400 N HARBOR BLVD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4126
Mailing Address - Country:US
Mailing Address - Phone:714-681-9070
Mailing Address - Fax:714-773-4788
Practice Address - Street 1:1400 N HARBOR BLVD
Practice Address - Street 2:SUITE 440
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4126
Practice Address - Country:US
Practice Address - Phone:714-681-9070
Practice Address - Fax:714-773-4788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19509Medicare ID - Type Unspecified