Provider Demographics
NPI:1871004960
Name:CENTER FOR NEUROPSYCHOLOGICAL SERVICES CNS
Entity Type:Organization
Organization Name:CENTER FOR NEUROPSYCHOLOGICAL SERVICES CNS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-895-0409
Mailing Address - Street 1:292 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3308
Mailing Address - Country:US
Mailing Address - Phone:954-579-4096
Mailing Address - Fax:833-375-3114
Practice Address - Street 1:1817 LEWIS TURNER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-499-0759
Practice Address - Fax:833-375-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9518103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty