Provider Demographics
NPI:1497097000
Name:CENTER FOR BRAIN TRAINING
Entity Type:Organization
Organization Name:CENTER FOR BRAIN TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-744-7616
Mailing Address - Street 1:550 HERITAGE DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3029
Mailing Address - Country:US
Mailing Address - Phone:561-206-2706
Mailing Address - Fax:888-576-2394
Practice Address - Street 1:550 HERITAGE DR STE 140
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-206-2706
Practice Address - Fax:888-624-6184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty