Provider Demographics
NPI:1376907972
Name:BRAIN HEALTH INCORPORATED
Entity Type:Organization
Organization Name:BRAIN HEALTH INCORPORATED
Other - Org Name:BHI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:413-687-7612
Mailing Address - Street 1:195 RUSSELL ST UNIT B13
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-9530
Mailing Address - Country:US
Mailing Address - Phone:413-687-7612
Mailing Address - Fax:888-932-6257
Practice Address - Street 1:195 RUSSELL ST UNIT B13
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9530
Practice Address - Country:US
Practice Address - Phone:413-687-7612
Practice Address - Fax:888-932-6257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-09
Last Update Date:2016-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7324174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty