Provider Demographics
NPI:1881134179
Name:COMPREHENSIVE PSYCHOLOGICAL SERVICES OF BREVARD, INC.
Entity type:Organization
Organization Name:COMPREHENSIVE PSYCHOLOGICAL SERVICES OF BREVARD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MADY
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-802-3430
Mailing Address - Street 1:2323 S BABCOCK ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5300
Mailing Address - Country:US
Mailing Address - Phone:321-802-3430
Mailing Address - Fax:321-802-6031
Practice Address - Street 1:2323 S BABCOCK ST
Practice Address - Street 2:SUITE B
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5300
Practice Address - Country:US
Practice Address - Phone:321-802-3430
Practice Address - Fax:321-802-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8977251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health