Provider Demographics
NPI:1356925861
Name:NEUROCOVE BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:NEUROCOVE BEHAVIORAL HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENSON
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MUNYAN
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD
Authorized Official - Phone:321-754-9099
Mailing Address - Street 1:3564 AVALON PARK E BLVD STE 1
Mailing Address - Street 2:IPMB 3039
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6350
Mailing Address - Country:US
Mailing Address - Phone:321-754-9099
Mailing Address - Fax:
Practice Address - Street 1:1317 EDGEWATER DR # 117
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6350
Practice Address - Country:US
Practice Address - Phone:321-754-9099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1AOUIOtherBCBS FLORIDA BLUE