Healthcare Provider Details

I. General information

NPI: 1225661473
Provider Name (Legal Business Name): THE CENTER FOR ADVANCED NEUROSCIENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13337 SW 44TH ST
DAVIE FL
33330-4713
US

IV. Provider business mailing address

13337 SW 44TH ST
DAVIE FL
33330-4713
US

V. Phone/Fax

Practice location:
  • Phone: 305-305-9055
  • Fax:
Mailing address:
  • Phone: 305-305-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH M KEENER
Title or Position: OWNER/CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 305-305-9055