Healthcare Provider Details

I. General information

NPI: 1003424730
Provider Name (Legal Business Name): NEUROBEHAVIORAL INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 N UNIVERSITY DR STE 101
CORAL SPRINGS FL
33067-4640
US

IV. Provider business mailing address

5441 N UNIVERSITY DR STE 101
CORAL SPRINGS FL
33067-4640
US

V. Phone/Fax

Practice location:
  • Phone: 954-803-9002
  • Fax: 954-933-2305
Mailing address:
  • Phone: 954-803-9002
  • Fax: 954-933-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: MARILYN COLANTUNO
Title or Position: ADMIN
Credential:
Phone: 954-803-9002