| Capital City Neuropsychology, Llc | |
|
6000 Garners Ferry Rd Ste 12 Columbia SC 29209-1303 | |
| (803) 790-7095 | |
| Not Available |
| Full Name | Capital City Neuropsychology, Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 6000 Garners Ferry Rd Ste 12, Columbia, South Carolina |
| Authorized Official Name and Position | Brandon Lars Roberg (CLINICAL NEUROPSYCHOLOGIST) |
| Authorized Official Contact | 8037087095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Capital City Neuropsychology, Llc 6000 Garners Ferry Rd Ste 12 Columbia SC 29209-1303 Ph: (803) 708-7095 | Capital City Neuropsychology, Llc 6000 Garners Ferry Rd Ste 12 Columbia SC 29209-1303 Ph: (803) 790-7095 |
| NPI Number | 1801352695 |
|---|---|
| Provider Enumeration Date | 02/16/2019 |
| Last Update Date | 01/18/2022 |
| Certification Date | 01/18/2022 |
| Medicare PECOS PAC ID | 9133452212 |
|---|---|
| Medicare Enrollment ID | O20190604002352 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801352695 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| Provider Name | Brandon Lars Roberg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649798737 PECOS PAC ID: 0042543126 Enrollment ID: I20190604002495 |
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