Healthcare Provider Details

I. General information

NPI: 1447056387
Provider Name (Legal Business Name): COMPLETE MIND CARE BRAIN WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6991 N STATE ROAD 7 STE 100
COCONUT CREEK FL
33073-4327
US

IV. Provider business mailing address

715 TWINING RD STE 120
DRESHER PA
19025-1832
US

V. Phone/Fax

Practice location:
  • Phone: 215-254-6000
  • Fax: 215-754-1705
Mailing address:
  • Phone: 215-254-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANE SYROP
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 215-254-6000