Provider Demographics
NPI:1487015491
Name:NEUROCORTEX PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:NEUROCORTEX PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:MOLINET
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-669-2549
Mailing Address - Street 1:11520 SW 69TH CT
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-4734
Mailing Address - Country:US
Mailing Address - Phone:305-669-2549
Mailing Address - Fax:877-579-7427
Practice Address - Street 1:11520 SW 69TH CT
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-4734
Practice Address - Country:US
Practice Address - Phone:305-669-2549
Practice Address - Fax:877-579-7427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7041103G00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty