Provider Demographics
NPI:1922476985
Name:CLINICAL NEUROPSYCHOLOGY CENTER LLC
Entity Type:Organization
Organization Name:CLINICAL NEUROPSYCHOLOGY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:754-281-6634
Mailing Address - Street 1:8610 LAKESIDE BND
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2884
Mailing Address - Country:US
Mailing Address - Phone:877-711-2128
Mailing Address - Fax:877-711-2128
Practice Address - Street 1:200 OAKWOOD LN
Practice Address - Street 2:100
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-1929
Practice Address - Country:US
Practice Address - Phone:877-711-2128
Practice Address - Fax:877-711-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9314261QM0850X, 311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)