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General NPI Number Information
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NPI Number | 1245155035
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Entity Type | Organization
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Legal Business Name | PHOENIX NEUROFEEDBACK AND MENTAL HEALTH CENTER LLC
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Dates
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Enumeration Date | 08/11/2026
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Last Update Date | 08/11/2026
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Provider Practice Location Address
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Address Line | 1 TAUNTON GRN STE 6
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City | TAUNTON
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State | MA
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Zip | 02780-3225
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Country | US
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Telephone | 774-240-9473
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Fax | 508-819-3003
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Provider Business Mailing Address
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Address Line | 150 RICHMOND ST
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City | RAYNHAM
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State | MA
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Zip | 02767-1308
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Country | US
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Telephone | 774-240-9473
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DJARA HAMPTON
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Credential |
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Telephone | 774-240-9473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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