| Organization Name: | MARIN NEUROPSYCHOLOGY AND PSYCHOLOGICAL CENTER, PC |
| NPI Number: | 1003102393 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDGAR ANGELONE (PRESIDENT) |
| Mailing Address: | 2154 4th St San Rafael |
| State: | CA US |
| Postal Code: | 949012684 |
| Phone Number: | 4154573451 |
| Fax Number: | 4154573819 |
| NPI Enumeration Date: | 06/24/2011 |
| NPI Last Update Date: | 06/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | PSY13957 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Clinical Neuropsychologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |