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General NPI Number Information
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NPI Number | 1073204913
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Entity Type | Organization
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Legal Business Name | HEALTHY BRAIN CENTER, A LICENSED CLINICAL SOCIAL WORK
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 2450 SAMARITAN DR
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City | SAN JOSE
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State | CA
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Zip | 95124-3912
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Country | US
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Telephone | 408-438-3604
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 SAMARITAN DR
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City | SAN JOSE
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State | CA
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Zip | 95124-3912
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Country | US
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Telephone | 408-438-3604
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LINDSAY SMITH
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Credential |
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Telephone | 408-438-3604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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