Provider Demographics
NPI:1316149362
Name:BORGARO NEUROPSYCHOLOGY SERVICES, LLC
Entity type:Organization
Organization Name:BORGARO NEUROPSYCHOLOGY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGARO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-300-1508
Mailing Address - Street 1:11445 E VIA LINDA
Mailing Address - Street 2:SUITE 2, PMB 473
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2654
Mailing Address - Country:US
Mailing Address - Phone:602-300-1508
Mailing Address - Fax:602-277-5848
Practice Address - Street 1:300 W CLARENDON
Practice Address - Street 2:SUITE 130
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3421
Practice Address - Country:US
Practice Address - Phone:602-300-1508
Practice Address - Fax:602-277-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3457103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ105844Medicare ID - Type Unspecified