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General NPI Number Information
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NPI Number | 1922476985
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Entity Type | Organization
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Legal Business Name | CLINICAL NEUROPSYCHOLOGY CENTER LLC
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Dates
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Enumeration Date | 09/08/2015
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 200 OAKWOOD LN 100
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City | HOLLYWOOD
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State | FL
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Zip | 33020-1929
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Country | US
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Telephone | 877-711-2128
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Fax | 877-711-2128
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Provider Business Mailing Address
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Address Line | 8610 LAKESIDE BND
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City | PARKLAND
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State | FL
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Zip | 33076-2884
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Country | US
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Telephone | 877-711-2128
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Fax | 877-711-2128
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST
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Name | DR. MICHAEL COLLINS
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Credential | PHD
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Telephone | 754-281-6634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | PY9314
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | PY9314
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License Number State | FL
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