| Neuropsychology Service Pa | |
|
277 State Street Suite 2a Bangor ME 04401-5440 | |
| (207) 990-2580 | |
| (207) 990-1930 |
| Full Name | Neuropsychology Service Pa |
|---|---|
| Speciality | Psychologist |
| Location | 277 State Street, Bangor, Maine |
| Authorized Official Name and Position | Royal G Grueneich (PRESIDENT) |
| Authorized Official Contact | 2079902580 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neuropsychology Service Pa 277 State St Suite 2a Bangor ME 04401-5439 Ph: (207) 990-2580 | Neuropsychology Service Pa 277 State Street Suite 2a Bangor ME 04401-5440 Ph: (207) 990-2580 |
| NPI Number | 1811100068 |
|---|---|
| Provider Enumeration Date | 05/07/2007 |
| Last Update Date | 12/02/2010 |
| Medicare PECOS PAC ID | 6608896709 |
|---|---|
| Medicare Enrollment ID | O20051205000448 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811100068 | NPI | - | NPPES |
| 5418635 | Other | AETNA | |
| P0724 | Other | ANTHEM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Royal G Grueneich |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437138765 PECOS PAC ID: 0547280554 Enrollment ID: I20051205000715 |
| Provider Name | Lola C Bogyo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689891384 PECOS PAC ID: 8022103845 Enrollment ID: I20090804000500 |
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