Provider Demographics
NPI:1437844842
Name:MY GOOD BRAIN INC
Entity Type:Organization
Organization Name:MY GOOD BRAIN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-395-6551
Mailing Address - Street 1:35640 FREMONT BLVD # 123
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3420
Mailing Address - Country:US
Mailing Address - Phone:510-497-0478
Mailing Address - Fax:
Practice Address - Street 1:3893 FIANO CMN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-2280
Practice Address - Country:US
Practice Address - Phone:510-497-0478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health