Provider Demographics
NPI:1336800754
Name:HEADWAY NEUROPSYCHOLOGY CENTER LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:HEADWAY NEUROPSYCHOLOGY CENTER LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CELENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FYFFE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-270-3307
Mailing Address - Street 1:2060 WINTER SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9347
Mailing Address - Country:US
Mailing Address - Phone:850-270-3307
Mailing Address - Fax:
Practice Address - Street 1:2060 WINTER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9347
Practice Address - Country:US
Practice Address - Phone:850-270-3307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty