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NPI Code Detail

MEDICARE: NEUROBEHAVORIAL ALLIANCE LLC

MEDICARE: NEUROBEHAVORIAL ALLIANCE 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
1103T00000XPsychologist

General Provider Information

NPI Number : 1952969081
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEUROBEHAVORIAL ALLIANCE LLC
Provider Business Mailing Address
First Line : 3115 NW 10TH TER STE 103
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33309-5937
Country : US
Telephone Number : 954-603-0480
Fax Number :
Provider Business Practice Location Address
First Line : 11555 HERON BAY BLVD STE 200
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33076-3362
Country : US
Telephone Number : 954-603-0480
Fax Number :
Authorized Official
Title or Position : PWNER
Name : MARIAN ROSADO
Credential :
Telephone Number : 203-671-9950
Provider Enumeration Date : 06/04/2019
Last Update Date : 06/04/2019

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Directions to “NEUROBEHAVORIAL ALLIANCE LLC ” Practice Location

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