Organization Name: | STANFORD HOSPITAL AND CLINICS |
NPI Number: | 1295863405 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK BURDELLE (NEURODIAGNOSTIC LAB MANAGER) |
Mailing Address: | 300 Pasteur Drive Rm A343 Stanford |
State: | CA US |
Postal Code: | 943055235 |
Phone Number: | 6504987875 |
Fax Number: | 6504987868 |
NPI Enumeration Date: | 03/01/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | |
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. |