Provider Demographics
NPI:1386185841
Name:THERAPY FOR THE BRAIN, LLC
Entity Type:Organization
Organization Name:THERAPY FOR THE BRAIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CANARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:561-309-4767
Mailing Address - Street 1:6650 W INDIANTOWN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4628
Mailing Address - Country:US
Mailing Address - Phone:561-309-4767
Mailing Address - Fax:
Practice Address - Street 1:6650 W INDIANTOWN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4628
Practice Address - Country:US
Practice Address - Phone:561-309-4767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9308715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty