Provider Demographics
NPI:1902112717
Name:THE NEUROFORENSIC INSTITUTE AND THERAPEUTIC SERVICES INC.
Entity Type:Organization
Organization Name:THE NEUROFORENSIC INSTITUTE AND THERAPEUTIC SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CICETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-734-6118
Mailing Address - Street 1:8198 JOG RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-2900
Mailing Address - Country:US
Mailing Address - Phone:561-734-6118
Mailing Address - Fax:561-963-3532
Practice Address - Street 1:8198 JOG RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2900
Practice Address - Country:US
Practice Address - Phone:561-734-6118
Practice Address - Fax:561-963-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7715103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL472026Medicaid
FL472026Medicaid