MEDICARE: INSTITUTE BRAZIL USA INTERNATIONAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103G00000X	Clinical Neuropsychologist
3	103T00000X	Psychologist
4	103TC2200X	Clinical Child & Adolescent Psychologist
5	103TF0000X	Family Psychologist
6	103TF0200X	Forensic Psychologist
7	103TR0400X	Rehabilitation Psychologist
8	1041C0700X	Clinical Social Worker
9	1041S0200X	School Social Worker
10	133N00000X	Nutritionist
11	171100000X	Acupuncturist
12	172V00000X	Community Health Worker
13	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
14	225100000X	Physical Therapist
15	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1912651597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE BRAZIL USA INTERNATIONAL

Provider Business Mailing Address
First Line	:	84 LAKE ST
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03060-4431
Country	:	US
Telephone Number	:	603-341-0217
Fax Number	:

Provider Business Practice Location Address
First Line	:	84 LAKE ST
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03060-4431
Country	:	US
Telephone Number	:	603-341-0217
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGY
Name	:	ISABEL GONTIJO
Credential	:	PHD
Telephone Number	:	603-341-0217

Provider Enumeration Date	:	02/11/2022
Last Update Date	:	02/11/2022

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