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General NPI Number Information
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NPI Number | 1760208714
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Entity Type | Organization
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Legal Business Name | THE NEUROFEEDBACK INSTITUTE, PA
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 1605 TOWN CENTER BLVD STE D
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City | WESTON
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State | FL
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Zip | 33326-3637
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Country | US
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Telephone | 786-505-2485
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Fax | 954-389-7600
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Provider Business Mailing Address
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Address Line | 1416 SANTA CRUZ AVE
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City | CORAL GABLES
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State | FL
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Zip | 33134-2258
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Country | US
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Telephone | 305-785-6610
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Fax | 954-389-7600
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REGLA JOSEFINA BLANCO
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Credential | PSY.D.
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Telephone | 305-785-6610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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