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General NPI Number Information
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NPI Number | 1487015491
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Entity Type | Organization
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Legal Business Name | NEUROCORTEX PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 11520 SW 69TH CT
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City | PINECREST
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State | FL
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Zip | 33156-4734
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Country | US
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Telephone | 305-669-2549
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Fax | 877-579-7427
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Provider Business Mailing Address
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Address Line | 11520 SW 69TH CT
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City | PINECREST
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State | FL
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Zip | 33156-4734
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Country | US
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Telephone | 305-669-2549
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Fax | 877-579-7427
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Authorized Official
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Title or Position | OPERATING MANAGER
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Name | DR. MARGIE MOLINET MOLINA
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Credential | PSYD
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Telephone | 305-669-2549
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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 | PY7041
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PY7041
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7041
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License Number State | FL
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