Neuropsychological Services of Tidewater, LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

0810004265 Issued in VA

Legal business name

NEUROPSYCHOLOGICAL SERVICES OF TIDEWATER, LLC

Practice address

2005 Pleasure House Rd
Virginia Beach, VA 23455

Phone

(757) 301-2248

Fax

(757) 689-8378

NPI assigned

Nov 16, 2017

Last updated

Mar 1, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jamie Ducharme, PHDNPI 1659533610

Title

Clinical Neuropsychologist

Phone

(757) 301-2248

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jamie Ducharme, PHD

  • Clinical Neuropsychologist
  • Virginia Beach, VA
  • NPI 1659533610
  Medicare reassignment Care Compare group NPD Authorized official
• Brianna Bowman, LCSW

  • Clinical Social Worker
  • Chesapeake, VA
  • NPI 1205523677
  Medicare reassignment Care Compare group NPD
• Elizabeth R Jenks, PSYD

  • Clinical Psychologist
  • Virginia Beach, VA
  • NPI 1548961378

  Clinical Neuropsychologist

  Medicare reassignment Care Compare group NPD
• Kimberley S. Coddington, PH.D.

  • Psychologist
  • Meadville, PA
  • NPI 1467423756

  VA

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1510790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551398400000",
    "number": "1366956096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 PLEASURE HOUSE RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234552709",
            "telephone_number": "757-301-2248",
            "fax_number": "757-689-8378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 PLEASURE HOUSE RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23455",
            "telephone_number": "757-301-2248",
            "fax_number": "757-689-8378"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "575 Lynnhaven Pkwy Ste 278",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234527476",
            "country_code": "US",
            "telephone_number": "757-301-2248",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "575 Lynnhaven Pkwy Ste 278",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234527476",
            "country_code": "US",
            "telephone_number": "757-301-2248",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NEUROPSYCHOLOGICAL SERVICES OF TIDEWATER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-16",
        "last_updated": "2019-03-01",
        "status": "A",
        "authorized_official_last_name": "DUCHARME",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "CLINICAL NEUROPSYCHOLOGIST",
        "authorized_official_telephone_number": "757-301-2248",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "VA",
            "license": "0810004265",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Lee Neubeck, M.ED., CCC-SLP
• Neuroenhancement & Cognitive Optimization Associates, PLLC (Neucoa)
• Neurohive Therapeutic Collaborative, LLC
• Neurology Consulants of Tidewater PLLC (Virginia Beach Neurology)
• Neurology Institute of Virginia, PLLC
• Kelly Nevala, LMT
• Stephanie Nevin, PSY.D.
• New Beginnings Psychotherapy Consultants, LLC
• New Beginnings Residential Supportive Care Services LLC
• New Chance Today LLC

• Clinical Neuropsychologist in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Clinical Neuropsychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.