Provider Demographics
NPI:1073210555
Name:BRAINERGIZE LLC
Entity Type:Organization
Organization Name:BRAINERGIZE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUIZ OLMEDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:518-620-1670
Mailing Address - Street 1:617 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NEW HAMPSHIRE
Mailing Address - Zip Code:03060
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:923 ELM ST
Practice Address - Street 2:PMB 10
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2003
Practice Address - Country:US
Practice Address - Phone:518-620-1670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty