Provider Demographics
NPI:1215414883
Name:CEREBRO, INC.
Entity Type:Organization
Organization Name:CEREBRO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:WINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-369-8344
Mailing Address - Street 1:1510 COLUMBINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-7943
Mailing Address - Country:US
Mailing Address - Phone:720-369-8344
Mailing Address - Fax:
Practice Address - Street 1:1510 COLUMBINE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-7943
Practice Address - Country:US
Practice Address - Phone:303-841-9863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO467482084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty