Healthcare Provider Details
I. General information
NPI: 1013718642
Provider Name (Legal Business Name): HEALTHY BRAIN PSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7520 NW 5TH ST STE 200G
PLANTATION FL
33317-1613
US
IV. Provider business mailing address
7520 NW 5TH ST STE 200G
PLANTATION FL
33317-1613
US
V. Phone/Fax
- Phone: 954-583-4324
- Fax:
- Phone: 954-583-4324
- Fax: 954-580-6885
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103G00000X |
| Taxonomy | Clinical Neuropsychologist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC0700X |
| Taxonomy | Clinical Psychologist |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC2200X |
| Taxonomy | Clinical Child & Adolescent Psychologist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
EVELYN
MARGARITA
RAMIREZ
Title or Position: FOUNDER/CEO
Credential: PHD
Phone: 561-696-2412