Provider Demographics
NPI:1376931519
Name:NEURORECOVERY INC
Entity Type:Organization
Organization Name:NEURORECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CICETTI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMHC
Authorized Official - Phone:561-734-6118
Mailing Address - Street 1:1101 N CONGRESS AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3336
Mailing Address - Country:US
Mailing Address - Phone:561-734-6118
Mailing Address - Fax:561-369-3275
Practice Address - Street 1:1101 N CONGRESS AVE STE 208
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3336
Practice Address - Country:US
Practice Address - Phone:561-734-6118
Practice Address - Fax:561-369-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7715103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAN583Medicare PIN