Provider Demographics
NPI:1851684906
Name:MAIN LINE NEUROPSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:MAIN LINE NEUROPSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BADGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-500-4700
Mailing Address - Street 1:43 PAOLI PLZ UNIT 1448
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-5044
Mailing Address - Country:US
Mailing Address - Phone:610-500-4700
Mailing Address - Fax:
Practice Address - Street 1:30 S VALLEY RD
Practice Address - Street 2:SUITE 207
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1450
Practice Address - Country:US
Practice Address - Phone:610-500-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016840103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TH0100X, 103TM1800X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty