Provider Demographics
NPI:1053771196
Name:CLINICAL PSYCHOLOGY SOLUTIONS PLLC
Entity type:Organization
Organization Name:CLINICAL PSYCHOLOGY SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEDELISKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-331-1503
Mailing Address - Street 1:318 S B ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-4092
Mailing Address - Country:US
Mailing Address - Phone:917-331-1503
Mailing Address - Fax:
Practice Address - Street 1:318 S B ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4092
Practice Address - Country:US
Practice Address - Phone:917-331-1503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26298103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty