Healthcare Provider Details

I. General information

NPI: 1376931519
Provider Name (Legal Business Name): NEURORECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N CONGRESS AVE STE 208
BOYNTON BEACH FL
33426-3336
US

IV. Provider business mailing address

1101 N CONGRESS AVE STE 208
BOYNTON BEACH FL
33426-3336
US

V. Phone/Fax

Practice location:
  • Phone: 561-734-6118
  • Fax: 561-369-3275
Mailing address:
  • Phone: 561-734-6118
  • Fax: 561-369-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY7715
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY7715
License Number StateFL

VIII. Authorized Official

Name: LISA CICETTI
Title or Position: OWNER
Credential: PSYD., LMHC
Phone: 561-734-6118