Provider Demographics
NPI:1952969081
Name:NEUROBEHAVORIAL ALLIANCE LLC
Entity Type:Organization
Organization Name:NEUROBEHAVORIAL ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-671-9950
Mailing Address - Street 1:3115 NW 10TH TER STE 103
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5937
Mailing Address - Country:US
Mailing Address - Phone:954-603-0480
Mailing Address - Fax:
Practice Address - Street 1:11555 HERON BAY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3362
Practice Address - Country:US
Practice Address - Phone:954-603-0480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty