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General NPI Number Information
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NPI Number | 1447519418
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Entity Type | Organization
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Legal Business Name | WHOLE AGAIN INSTUTE FOR WELLNESS, INC
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 12781 MIRAMAR PARKWAY SUITE 1-105
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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 | 786-345-0776
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Provider Business Mailing Address
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Address Line | 12781 MIRAMAR PARKWAY SUITE 1-105
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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 |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | JESSICA E RIVERA
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Credential | PSY.D.
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Telephone | 954-933-8299
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | FL
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