Healthcare Provider Details

I. General information

NPI: 1013319656
Provider Name (Legal Business Name): BRAIN PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 02/05/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 E. 98TH STREET SUITE # 107
INDIANAPOLIS IN
46280
US

IV. Provider business mailing address

3003 E. 98TH STREET SUITE # 107
INDIANAPOLIS IN
46280
US

V. Phone/Fax

Practice location:
  • Phone: 463-273-2093
  • Fax: 317-672-1971
Mailing address:
  • Phone: 463-273-2093
  • Fax: 317-672-1971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES SORGI
Title or Position: OWNER
Credential:
Phone: 317-441-8499