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General NPI Number Information
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NPI Number | 1265709521
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Entity Type | Organization
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Legal Business Name | WHOLE AGAIN NEUROPSYCHOLOGY CENTER INC
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 14601 HOTEL ROAD SUITE 101B
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City | MIRAMAR
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State | FL
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Zip | 33027
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Country | US
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Telephone | 954-933-8299
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Fax |
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Provider Business Mailing Address
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Address Line | 14601 SW 29TH ST STE 101B
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City | MIRAMAR
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State | FL
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Zip | 33027-4714
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Country | US
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Telephone | 954-933-8299
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Fax |
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Authorized Official
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Title or Position | PRESIDENET
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Name | DR. JESSICA RIVERA
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Credential | PSY.D.
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Telephone | 305-495-2130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY8359
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License Number State | FL
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