Provider Demographics
NPI:1508508052
Name:COGNITIVE HEALTH NETWORK CORP
Entity Type:Organization
Organization Name:COGNITIVE HEALTH NETWORK CORP
Other - Org Name:COGNITIVE HEALTH NETWORK
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-557-6755
Mailing Address - Street 1:5801 NW 151ST ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2437
Mailing Address - Country:US
Mailing Address - Phone:305-557-6755
Mailing Address - Fax:305-557-1636
Practice Address - Street 1:5801 NW 151ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2494
Practice Address - Country:US
Practice Address - Phone:305-557-6755
Practice Address - Fax:305-557-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty