Provider Demographics
| NPI: | 1265218416 |
|---|---|
| Name: | NERVOUS SYSTEM CLINIC RENOVAR, LLC |
| Entity type: | Organization |
| Organization Name: | NERVOUS SYSTEM CLINIC RENOVAR, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ROSARIO |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | LOZANO |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 202-758-7243 |
| Mailing Address - Street 1: | 8901 NEW HAMPSHIRE AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SILVER SPRING |
| Mailing Address - State: | MD |
| Mailing Address - Zip Code: | 20903-3611 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 301-580-1313 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 8901 NEW HAMPSHIRE AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | SILVER SPRING |
| Practice Address - State: | MD |
| Practice Address - Zip Code: | 20903-3611 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 202-241-0581 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2023-09-05 |
| Last Update Date: | 2024-02-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | ||
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | |
| No | 283Q00000X | Hospitals | Psychiatric Hospital | Group - Multi-Specialty | |
| No | 283X00000X | Hospitals | Rehabilitation Hospital | Group - Multi-Specialty | |
| No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | Group - Multi-Specialty | |
| No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | ||
| No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
