Provider Demographics
NPI:1326886656
Name:WELLESLEY NEUROPSYCHOLOGY AND ASSESSMENT PLLC
Entity type:Organization
Organization Name:WELLESLEY NEUROPSYCHOLOGY AND ASSESSMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARNSBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-447-3178
Mailing Address - Street 1:892 WORCESTER ST STE 210
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-3729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:892 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-3718
Practice Address - Country:US
Practice Address - Phone:617-249-4557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty