Provider Demographics
NPI:1518054998
Name:BEHAVIORAL MEDICINE & BIOFEEDBACK CONSULTANTS INC
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE & BIOFEEDBACK CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:TRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-783-5100
Mailing Address - Street 1:150 SW 12TH AVE
Mailing Address - Street 2:SUITE #330
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3298
Mailing Address - Country:US
Mailing Address - Phone:954-783-5100
Mailing Address - Fax:954-783-5176
Practice Address - Street 1:150 SW 12TH AVE
Practice Address - Street 2:SUITE #330
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3298
Practice Address - Country:US
Practice Address - Phone:954-783-5100
Practice Address - Fax:954-783-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3620103TC0700X
FLPY7394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38128Medicare ID - Type Unspecified