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General NPI Number Information
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NPI Number | 1972827921
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Entity Type | Organization
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Legal Business Name | NEUROCYCLES WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 03/19/2010
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Last Update Date | 03/19/2010
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Provider Practice Location Address
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Address Line | 401 ALBERTO WAY STE C2
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City | LOS GATOS
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State | CA
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Zip | 95032-5404
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Country | US
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Telephone | 408-353-9970
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Fax | 408-353-9970
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Provider Business Mailing Address
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Address Line | 401 ALBERTO WAY STE C2
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City | LOS GATOS
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State | CA
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Zip | 95032-5404
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Country | US
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Telephone | 408-353-9970
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Fax | 408-353-9970
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. AMY WEINGARTEN
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Credential | LCSW
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Telephone | 408-353-9970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 19067
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC37655
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 58381
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15027
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License Number State | CA
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