Provider Demographics
NPI:1225661473
Name:THE CENTER FOR ADVANCED NEUROSCIENCES
Entity Type:Organization
Organization Name:THE CENTER FOR ADVANCED NEUROSCIENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KEENER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-305-9055
Mailing Address - Street 1:13337 SW 44TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4713
Mailing Address - Country:US
Mailing Address - Phone:305-305-9055
Mailing Address - Fax:
Practice Address - Street 1:13337 SW 44TH ST
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4713
Practice Address - Country:US
Practice Address - Phone:305-305-9055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health