| Southwest Michigan Neuropsychology Pc | |
|
238 Hoover Blvd Ste 20 Holland MI 49423-3755 | |
| (517) 887-9801 | |
| Not Available |
| Full Name | Southwest Michigan Neuropsychology Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 238 Hoover Blvd Ste 20, Holland, Michigan |
| Authorized Official Name and Position | Robert Fabiano (PRESIDENT) |
| Authorized Official Contact | 5172437027 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Michigan Neuropsychology Pc 238 Hoover Blvd Ste 20 Holland MI 49423-3755 Ph: () - | Southwest Michigan Neuropsychology Pc 238 Hoover Blvd Ste 20 Holland MI 49423-3755 Ph: (517) 887-9801 |
| NPI Number | 1700454642 |
|---|---|
| Provider Enumeration Date | 06/16/2021 |
| Last Update Date | 06/16/2021 |
| Certification Date | 06/16/2021 |
| Medicare PECOS PAC ID | 0648673020 |
|---|---|
| Medicare Enrollment ID | O20210722001316 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700454642 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Brooke E Vanburen-hay |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043277239 PECOS PAC ID: 9234106329 Enrollment ID: I20040916001122 |
| Provider Name | Robert J Fabiano |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629157185 PECOS PAC ID: 1759277569 Enrollment ID: I20041013000443 |
| Provider Name | Jasmine Starr Emerick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255744413 PECOS PAC ID: 8123323607 Enrollment ID: I20160222000530 |
| Provider Name | Alfred Mansour |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275876963 PECOS PAC ID: 1254636616 Enrollment ID: I20160223000373 |
| Provider Name | Julie Simensky |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538172283 PECOS PAC ID: 8527028752 Enrollment ID: I20210226001671 |
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