Provider Demographics
NPI:1528639713
Name:NEW ENGLAND PSYCHOLOGICAL &NEUROPSYCHOLOGICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:NEW ENGLAND PSYCHOLOGICAL &NEUROPSYCHOLOGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYALAKKARA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:508-816-8787
Mailing Address - Street 1:208 SCARBOROUGH LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-7547
Mailing Address - Country:US
Mailing Address - Phone:860-770-7779
Mailing Address - Fax:860-638-4638
Practice Address - Street 1:175 CAPITAL BLVD STE 402
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3914
Practice Address - Country:US
Practice Address - Phone:508-816-8787
Practice Address - Fax:860-638-4638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty