Organization Name: | LONG ISLAND NEUROPSYCHOLOGY, P.C. |
NPI Number: | 1356467419 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHANE S. BUSH (PRESIDENT) |
Mailing Address: | 290 Hawkins Ave Suite B Lake Ronkonkoma |
State: | NY US |
Postal Code: | 117799600 |
Phone Number: | 6313347884 |
Fax Number: | |
NPI Enumeration Date: | 03/21/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 012998 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | NY |
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. |