Provider Demographics
NPI:1497003974
Name:BRAIN ENHANCEMENT INSTITUTE
Entity Type:Organization
Organization Name:BRAIN ENHANCEMENT INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-305-1645
Mailing Address - Street 1:8055 W MANCHESTER AVE
Mailing Address - Street 2:STE 720
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7960
Mailing Address - Country:US
Mailing Address - Phone:310-305-1654
Mailing Address - Fax:310-496-2957
Practice Address - Street 1:8055 W MANCHESTER AVE
Practice Address - Street 2:STE 720
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7960
Practice Address - Country:US
Practice Address - Phone:310-305-1654
Practice Address - Fax:310-496-2957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67163103G00000X
CA18502106H00000X
CAA72354208000000X
CA10919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty