Healthcare Provider Details

I. General information

NPI: 1588932925
Provider Name (Legal Business Name): NEUROFEEDBACK AND BRAIN FITNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 WESTWOOD OFFICE PARK
FREDERICKSBURG VA
22401-5121
US

IV. Provider business mailing address

810 WESTWOOD OFFICE PARK
FREDERICKSBURG VA
22401-5121
US

V. Phone/Fax

Practice location:
  • Phone: 540-656-3114
  • Fax:
Mailing address:
  • Phone: 540-656-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateVA

VIII. Authorized Official

Name: KAVITA ARORA
Title or Position: PHYSICAL AND OCCUPATIONAL THERAPIST
Credential: PHD., MS OTR/L
Phone: 540-656-3114