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General NPI Number Information
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NPI Number | 1386185841
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Entity Type | Organization
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Legal Business Name | THERAPY FOR THE BRAIN, LLC
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 6650 W INDIANTOWN RD SUITE 110
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City | JUPITER
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State | FL
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Zip | 33458-4628
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Country | US
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Telephone | 561-309-4767
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Fax |
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Provider Business Mailing Address
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Address Line | 6650 W INDIANTOWN RD SUITE 110
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City | JUPITER
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State | FL
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Zip | 33458-4628
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Country | US
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Telephone | 561-309-4767
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | MRS. VICTORIA L CANARELLI
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Credential | ARNP
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Telephone | 561-309-4767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP 9308715
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License Number State | FL
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