Healthcare Provider Details

I. General information

NPI: 1033727433
Provider Name (Legal Business Name): BRAIN AND BEYOND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 N ANDREWS AVE STE 306
FORT LAUDERDALE FL
33309-4776
US

IV. Provider business mailing address

4101 N ANDREWS AVE STE 306
FORT LAUDERDALE FL
33309-4776
US

V. Phone/Fax

Practice location:
  • Phone: 305-720-1558
  • Fax:
Mailing address:
  • Phone: 305-720-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: ROHAN ALRIC BROWN
Title or Position: OWNER
Credential:
Phone: 305-720-1558