Healthcare Provider Details

I. General information

NPI: 1245155035
Provider Name (Legal Business Name): PHOENIX NEUROFEEDBACK AND MENTAL HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAUNTON GRN STE 6
TAUNTON MA
02780-3225
US

IV. Provider business mailing address

150 RICHMOND ST
RAYNHAM MA
02767-1308
US

V. Phone/Fax

Practice location:
  • Phone: 774-240-9473
  • Fax: 508-819-3003
Mailing address:
  • Phone: 774-240-9473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DJARA HAMPTON
Title or Position: OWNER
Credential:
Phone: 774-240-9473