Provider Demographics
NPI:1912160193
Name:NEUROSCIENCE CENTER
Entity Type:Organization
Organization Name:NEUROSCIENCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-431-5001
Mailing Address - Street 1:1401 CENTERVILLE RD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4647
Mailing Address - Country:US
Mailing Address - Phone:850-431-5001
Mailing Address - Fax:850-431-6101
Practice Address - Street 1:1401 CENTERVILLE RD
Practice Address - Street 2:SUITE 504
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4647
Practice Address - Country:US
Practice Address - Phone:850-431-5001
Practice Address - Fax:850-431-6101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TALLAHASSEE MEMORIAL HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
24766OOtherMEDICARE GROUP NUMBER