Neurosmart Psychological Associates, P.C.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Legal business name

NEUROSMART PSYCHOLOGICAL ASSOCIATES, P.C.

Practice address

309 Pirkle Ferry Rd
Suite a-200
Cumming, GA 30040-2546

Phone

(770) 889-2848

NPI assigned

Apr 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Kathryn C Black, PH.D.

Title

President

Phone

(770) 889-2848

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• NeuroSmart, Inc. Former legal business name

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302739200000",
    "number": "1639290299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 PIRKLE FERRY RD",
            "address_2": "SUITE A-200",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300402546",
            "telephone_number": "770-889-2848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 PIRKLE FERRY RD",
            "address_2": "SUITE A-200",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300402546",
            "telephone_number": "770-889-2848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROSMART PSYCHOLOGICAL ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2011-04-14",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-889-2848",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "614308690A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NeuroSmart, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Clinical Child & Adolescent Psychologist in Cumming, GA
• Providers in Cumming, GA by specialty
• Clinical Child & Adolescent Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.