Provider Demographics
NPI:1053705426
Name:CENTERFORBRAIN
Entity type:Organization
Organization Name:CENTERFORBRAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-744-7616
Mailing Address - Street 1:550 HERITAGE DR STE 140
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3033
Mailing Address - Country:US
Mailing Address - Phone:561-744-7616
Mailing Address - Fax:866-624-6184
Practice Address - Street 1:550 HERITAGE DR
Practice Address - Street 2:SUITE 140
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3029
Practice Address - Country:US
Practice Address - Phone:561-744-7616
Practice Address - Fax:866-624-6184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010138500Medicaid