Provider Demographics
NPI:1942696216
Name:BEHAVIORAL MEDICINE AND BIOFEEDBACK
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE AND BIOFEEDBACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-202-6200
Mailing Address - Street 1:150 SW 12TH AVE
Mailing Address - Street 2:#207
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3298
Mailing Address - Country:US
Mailing Address - Phone:954-202-6200
Mailing Address - Fax:954-202-6207
Practice Address - Street 1:150 SW 12TH AVE
Practice Address - Street 2:#207
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3298
Practice Address - Country:US
Practice Address - Phone:954-202-6200
Practice Address - Fax:954-202-6207
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIORAL MEDICINE AND BIOFEEDBACK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003620103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty