Provider Demographics
NPI:1972827921
Name:NEUROCYCLES WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:NEUROCYCLES WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINGARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:408-353-9970
Mailing Address - Street 1:401 ALBERTO WAY STE C2
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5404
Mailing Address - Country:US
Mailing Address - Phone:408-353-9970
Mailing Address - Fax:408-353-9970
Practice Address - Street 1:401 ALBERTO WAY STE C2
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5404
Practice Address - Country:US
Practice Address - Phone:408-353-9970
Practice Address - Fax:408-353-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150271041C0700X
CA190671041C0700X
CAMFC37655106H00000X
CA58381106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty