Provider Demographics
NPI:1871070052
Name:NEW CONNECTIONS NEUROPSYCHOLOGY, PC
Entity type:Organization
Organization Name:NEW CONNECTIONS NEUROPSYCHOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:KRUSE
Authorized Official - Last Name:BENS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:510-944-0221
Mailing Address - Street 1:1057 MACARTHUR BLVD
Mailing Address - Street 2:STE 214
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3000
Mailing Address - Country:US
Mailing Address - Phone:510-944-0221
Mailing Address - Fax:
Practice Address - Street 1:1057 MACARTHUR BLVD
Practice Address - Street 2:STE 214
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577
Practice Address - Country:US
Practice Address - Phone:510-944-0221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29300103G00000X, 103T00000X, 103TC0700X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891296760OtherNPPES