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NPI Code Detail

MEDICARE: BRAINERGIZE LLC

MEDICARE: BRAINERGIZE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1073210555
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRAINERGIZE LLC
Provider Business Mailing Address
First Line : 617 SOUTH MAIN STREET
Second Line :
City : NASHUA
State : NEW HAMPSHIRE
Zip : 03060
Country : UM
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 923 ELM ST
Second Line : PMB 10
City : MANCHESTER
State : NH
Zip : 03101-2003
Country : US
Telephone Number : 518-620-1670
Fax Number :
Authorized Official
Title or Position : OWNER
Name : CHRISTY M RUIZ OLMEDA
Credential : LCMHC
Telephone Number : 518-620-1670
Provider Enumeration Date : 02/14/2023
Last Update Date : 02/14/2023

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Directions to “BRAINERGIZE LLC ” Practice Location

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