Healthcare Provider Details

I. General information

NPI: 1922476985
Provider Name (Legal Business Name): CLINICAL NEUROPSYCHOLOGY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OAKWOOD LN 100
HOLLYWOOD FL
33020-1929
US

IV. Provider business mailing address

8610 LAKESIDE BND
PARKLAND FL
33076-2884
US

V. Phone/Fax

Practice location:
  • Phone: 877-711-2128
  • Fax: 877-711-2128
Mailing address:
  • Phone: 877-711-2128
  • Fax: 877-711-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPY9314
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberPY9314
License Number StateFL

VIII. Authorized Official

Name: DR. MICHAEL COLLINS
Title or Position: NEUROPSYCHOLOGIST
Credential: PHD
Phone: 754-281-6634