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General NPI Number Information
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NPI Number | 1659747749
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Entity Type | Organization
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Legal Business Name | COGNITIVE CARE PA
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 4565 US HIGHWAY 17 STE 106
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-4822
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Country | US
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Telephone | 904-579-2265
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Fax |
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Provider Business Mailing Address
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Address Line | 10950-60 SAN JOSE BLVD. SUITE 169
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City | JACKSONVILLE
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State | FL
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Zip | 32223
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Country | US
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Telephone | 904-770-5199
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER ROSSILLI
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Credential |
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Telephone | 904-579-2265
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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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