Healthcare Provider Details

I. General information

NPI: 1790933604
Provider Name (Legal Business Name): NEUROBEHAVIORAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MIRACLE MILE SUITE 330
CORAL GABLES FL
33134-5430
US

IV. Provider business mailing address

PO BOX 142064
CORAL GABLES FL
33114-2064
US

V. Phone/Fax

Practice location:
  • Phone: 305-445-9554
  • Fax: 786-235-1074
Mailing address:
  • Phone: 305-445-9554
  • Fax: 786-235-1074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY 0003733
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY4487
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 2120
License Number StateFL

VIII. Authorized Official

Name: DR. JORGE A HERRERA
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 305-445-9554