COMPREHENSIVE NEUROPSYCHOLOGICAL SERVICES PC (NPI# 1740549120) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740549120 |
| Entity Type | Organization |
| Organization Name | COMPREHENSIVE NEUROPSYCHOLOGICAL SERVICES PC |
| Practice Address |
7320 Garden Ln Portage MI 49002-4423 |
| Practice Telephone | 2692172992 |
| Practice Fax Number | 2693247707 |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2012-05-07 |
| Authorized Official Name | DR. ENNIS BERKER (PRESIDENT) |
| Authorized Official Telephone | 2692172992 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 6301006050 | MI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BLUE CROSS | 680C945730 | 01 |
| MI | MEDICARE PART B | 0M0-9810 | 01 |
| Street Address |
7320 GARDEN LN |
| City | PORTAGE |
| State | MI |
| Zip Code | 49002-4423 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598858409 | Ces Consultation, P.C. | Community/Behavioral Health | 7320 Garden Ln, Suite 110, Portage, MI 49002-4423 | 2006-10-02 |
| 1568737799 | Jessica A Kerby | Psychologist | 7320 Garden Ln, Portage, MI 49002-4423 | 2012-03-21 |
| 1881967909 | Lasondra Wayne | Counselor | 7320 Garden Ln, Suite 106, Portage, MI 49002-4423 | 2012-02-21 |
| 1821255423 | Kelly Dziedzic | Psychologist | 7320 Garden Ln, Suite 106, Portage, MI 49002-4423 | 2008-05-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932604204 | Susan Vandewalker | Physical Therapist | 8001 Angling Rd., Portage, MI 49002 | 2018-03-28 |
| 1134634934 | Portage Chiropractic and Wellness Center | Chiropractor | 609 E. Centre, Portage, MI 49002 | 2017-12-04 |
| 1548620537 | Patricia Eid | Behavioral Analyst | 1016 E Milham Ave, Suite 2, Portage, MI 49002 | 2016-03-03 |
| 1386045383 | Pinnacle Senior Care of Kalamazoo, LLC | Home Health | 2725 Airview Blvd Ste 105b, Portage, MI 49002 | 2014-09-09 |
| 1104241611 | Meredith Ayers Holland | Behavioral Analyst | 9616 Portage Road, Portage, MI 49002 | 2014-02-20 |
| 1619211919 | Daketia L Thomas | Massage Therapist | 8314 Portage Rd, Suite D, Kalamazoo, MI 49002 | 2012-11-27 |
| 1831457142 | Kinetic Kids, LLC | Occupational Therapist | 540 East Milham, Portage, MI 49002 | 2012-04-25 |
| 1154689404 | Lauren Michelle Mattaliano | Occupational Therapist | 540 E. Milham Road, Portage, MI 49002 | 2012-04-24 |
| 1114219227 | South Michigan Psychiatric Services LLC | Psychiatry & Neurology | 5390 Lovers Ln, Third Floor, Portage, MI 49002 | 2011-05-07 |
| 1174836316 | Premier Neuropsychiatry Plc | Psychiatry & Neurology | 5930 Lovers Lane, Portage, MI 49002 | 2010-07-16 |
| Find all providers in zip 49002 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| 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. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750472387 | John Thomas Gallagher | Clinical Neuropsychologist | 6100 Newport Rd, Suite 222, Portage, MI 49002-9235 | 2006-09-27 |
| 1780633388 | Sandra W Bowker | Clinical Neuropsychologist | 5148 Lovers Ln Ste 2, Portage, MI 49002-1572 | 2006-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265046098 | Axon Psychology Group, PC | Clinical Neuropsychologist | 1377 Stonecreek Ct, Saint Joseph, MI 49085-9795 | 2020-08-31 |
| 1548814965 | Emily Nicole Robinett-ferrara | Clinical Neuropsychologist | 14050 Kingston St, Oak Park, MI 48237-1140 | 2019-07-25 |
| 1649782244 | Matthew Kadrich | Clinical Neuropsychologist | 3334 Rochester Rd # 205, Troy, MI 48083-5426 | 2017-11-04 |
| 1992237176 | Lauren Marie Golla | Clinical Neuropsychologist | 111 E Court St Ste 1b, Flint, MI 48502-1649 | 2017-03-28 |
| 1750839783 | Ace Psychological Consultants LLC | Clinical Neuropsychologist | 1920 Livernois Rd Ste D, Troy, MI 48083-1770 | 2016-09-20 |
| 1922556406 | Kenya Hameed | Clinical Neuropsychologist | 111 East Court St, Suite 1b-1, Flint, MI 48502 | 2016-09-14 |
| 1841609369 | Crystal Young | Clinical Neuropsychologist | 1550 E Beltline Ave Se, Suite 340, Grand Rapids, MI 49506-4301 | 2014-08-08 |
| 1497165146 | Woojin Song | Clinical Neuropsychologist | 2101 Commonwealth Blvd Ste C, Ann Arbor, MI 48105-2969 | 2014-05-03 |
| 1831516152 | Ira Lourie, Psy.d., Pllc | Clinical Neuropsychologist | 30051 High Valley Rd, Farmington Hills, MI 48331-2144 | 2014-03-25 |
| 1306272042 | Erin Mark | Clinical Neuropsychologist | 2010 Hogback Rd Ste 6g, Ann Arbor, MI 48105-8800 | 2013-09-25 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.