MEDICARE: CLINICAL NEUROSCIENCE SOLUTIONS, INC.

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
1	261QR1100X	Research Clinic/Center

General Provider Information

NPI Number	:	1447527452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL NEUROSCIENCE SOLUTIONS, INC.

Provider Business Mailing Address
First Line	:	6750 TURKEY LAKE RD
Second Line	:	SUITE 300
City	:	ORLANDO
State	:	FL
Zip	:	32819-4736
Country	:	US
Telephone Number	:	407-903-1680
Fax Number	:	407-903-1578

Provider Business Practice Location Address
First Line	:	6750 TURKEY LAKE RD
Second Line	:	SUITE 300
City	:	ORLANDO
State	:	FL
Zip	:	32819-4736
Country	:	US
Telephone Number	:	407-903-1680
Fax Number	:	407-903-1578

Authorized Official
Title or Position	:	COO
Name	:	MR. DANIEL KEARNEY
Credential	:
Telephone Number	:	407-903-1680

Provider Enumeration Date	:	11/18/2011
Last Update Date	:	11/18/2011

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