Berks Neuropsychology, LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PS007441L Issued in PA

Legal business name

BERKS NEUROPSYCHOLOGY, LLC

Doing business as

David E. Nicodemus, Jr.

Practice address

1623 Morgantown Rd
Reading, PA 19607-9455

Phone

(610) 796-6422

Fax

(610) 796-6470

NPI assigned

Jun 1, 2016

Last updated

Jun 1, 2016By 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

Mr. David Edward Nicodemus Jr., M.A.NPI 1508083916

Title

Owner

Phone

(610) 921-3172

Specialties & licenses 2

Addresses

Other names 1

• David E. Nicodemus, Jr. Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Practitioners 1

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.

• David Edward Nicodemus Jr., M.A.

  • Clinical Psychologist
  • Reading, PA
  • NPI 1508083916

  Clinical Neuropsychologist

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1464739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464739200000",
    "number": "1790133742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 CAROLINA AVE",
            "city": "READING",
            "state": "PA",
            "postal_code": "196051102",
            "telephone_number": "610-921-3172",
            "fax_number": "610-796-6470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1623 MORGANTOWN RD",
            "city": "READING",
            "state": "PA",
            "postal_code": "196079455",
            "telephone_number": "610-796-6422",
            "fax_number": "610-796-6470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERKS NEUROPSYCHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-01",
        "last_updated": "2016-06-01",
        "status": "A",
        "authorized_official_last_name": "NICODEMUS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-921-3172",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "PA",
            "license": "PS007441L",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS007441L",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "David E. Nicodemus, Jr.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Neuropsychologist in Reading, PA
• Providers in Reading, PA by specialty
• Clinical Neuropsychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; 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.