Provider Demographics
NPI:1699497545
Name:PIVOTAL RESEARCH LLC
Entity type:Organization
Organization Name:PIVOTAL RESEARCH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-993-4567
Mailing Address - Street 1:12 MIDDLESEX RD UNIT 67122
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-6705
Mailing Address - Country:US
Mailing Address - Phone:617-993-4567
Mailing Address - Fax:
Practice Address - Street 1:1172 BEACON ST STE 101
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1147
Practice Address - Country:US
Practice Address - Phone:617-993-4567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty