Healthcare Provider Details

I. General information

NPI: 1023791738
Provider Name (Legal Business Name): VERO BEACH COGNITIVE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 17TH ST STE M
VERO BEACH FL
32960-5686
US

IV. Provider business mailing address

333 17TH ST STE M
VERO BEACH FL
32960-5686
US

V. Phone/Fax

Practice location:
  • Phone: 772-584-3083
  • Fax: 772-218-3003
Mailing address:
  • Phone: 772-584-3083
  • Fax: 772-218-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THERESA A PRESCOTT
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 772-584-3083