Provider Demographics
NPI:1073360632
Name:BRAIN HEALTH
Entity type:Organization
Organization Name:BRAIN HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BRAIN HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:KETAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMDAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-901-2269
Mailing Address - Street 1:7100 REGENCY SQUARE BLVD STE 288
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3202
Mailing Address - Country:US
Mailing Address - Phone:281-891-2242
Mailing Address - Fax:
Practice Address - Street 1:7100 REGENCY SQUARE BLVD STE 288
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3202
Practice Address - Country:US
Practice Address - Phone:281-891-2242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty