| Organization Name: | CORNERSTONE NEUROPSYCHOLOGY, LLC |
| NPI Number: | 1245675784 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RANDI NICHOLS MCDONALD (OWNER) |
| Mailing Address: | 1270 Eglin Pkwy Suite C-12 Shalimar |
| State: | FL US |
| Postal Code: | 325792306 |
| Phone Number: | 8506136677 |
| Fax Number: | 8506136993 |
| NPI Enumeration Date: | 05/09/2013 |
| NPI Last Update Date: | 05/09/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TM1800X |
| License Number: | PY7940 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Mental Retardation & Developmental Disabilities |
| Taxonomy Definition: | |