Provider Demographics
NPI:1245652031
Name:BRAIN WORKS & MIND MATTERS, LLC
Entity type:Organization
Organization Name:BRAIN WORKS & MIND MATTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MOXHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:302-324-5255
Mailing Address - Street 1:42 READS WAY
Mailing Address - Street 2:SUITE 135-136
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-1649
Mailing Address - Country:US
Mailing Address - Phone:302-324-5255
Mailing Address - Fax:302-323-8105
Practice Address - Street 1:42 READS WAY
Practice Address - Street 2:SUITE 135-136
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-1649
Practice Address - Country:US
Practice Address - Phone:302-324-5255
Practice Address - Fax:302-323-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2011605393251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2011605393OtherLICENSE NUMBER