Provider Demographics
NPI:1205559028
Name:FLORIDA NEUROPSYCHOLOGY GROUP PA
Entity type:Organization
Organization Name:FLORIDA NEUROPSYCHOLOGY GROUP PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST/PSYCHOLOGIST/PRES
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:772-365-4934
Mailing Address - Street 1:1860 82ND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-6998
Mailing Address - Country:US
Mailing Address - Phone:772-365-4934
Mailing Address - Fax:772-362-6901
Practice Address - Street 1:1860 82ND AVE STE 201
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-6998
Practice Address - Country:US
Practice Address - Phone:772-365-4934
Practice Address - Fax:772-362-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1750851887OtherINDIVIDUAL NPI