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General NPI Number Information
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NPI Number | 1871004960
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Entity Type | Organization
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Legal Business Name | CENTER FOR NEUROPSYCHOLOGICAL SERVICES CNS
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 04/24/2019
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Provider Practice Location Address
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Address Line | 1817 LEWIS TURNER BLVD
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547
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Country | US
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Telephone | 850-499-0759
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Fax | 833-375-3114
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Provider Business Mailing Address
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Address Line | 292 S UNIVERSITY DR
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City | PLANTATION
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State | FL
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Zip | 33324-3308
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Country | US
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Telephone | 954-579-4096
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Fax | 833-375-3114
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Authorized Official
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Title or Position | OWNER
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Name | ANA TERESA SANTANA
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Credential | PSY.D.
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Telephone | 954-895-0409
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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 | PY9518
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License Number State | FL
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