Organization Name: | NEUROCLINIC AND ASSESSMENTS, LLC |
NPI Number: | 1053673988 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSHUA C. LAVIGNE (DIRECTOR) |
Mailing Address: | 659 Ridgeview Dr Mchenry |
State: | IL US |
Postal Code: | 600507012 |
Phone Number: | 8153441999 |
Fax Number: | 8155165171 |
NPI Enumeration Date: | 06/15/2012 |
NPI Last Update Date: | 06/15/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 071008295 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
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. |