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General NPI Number Information
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NPI Number | 1326994815
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Entity Type | Organization
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Legal Business Name | BRAIN REVAMP CLINIC LLC
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 7900 SW 57TH AVE STE 24
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5546
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Country | US
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Telephone | 305-726-9757
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Fax |
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Provider Business Mailing Address
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Address Line | 14 NE 1ST AVE STE 14031225
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City | MIAMI
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State | FL
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Zip | 33132-2431
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Country | US
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Telephone | 786-383-2779
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Fax |
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Authorized Official
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Title or Position | LCSW/OWNER
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Name | ANGELICA V ROMERO
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Credential | LCSW LICSW
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Telephone | 786-383-2779
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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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