Provider Demographics
NPI:1821796400
Name:BRAIN EMPOWERMENT LLC
Entity Type:Organization
Organization Name:BRAIN EMPOWERMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISIANE
Authorized Official - Middle Name:GONCALVES
Authorized Official - Last Name:FIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-953-8077
Mailing Address - Street 1:8618 PALMER PARK CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-2405
Mailing Address - Country:US
Mailing Address - Phone:617-953-8077
Mailing Address - Fax:
Practice Address - Street 1:8618 PALMER PARK CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-2405
Practice Address - Country:US
Practice Address - Phone:617-953-8077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)