Provider Demographics
NPI:1548959935
Name:CHILDREN'S BRAIN ACADEMY
Entity type:Organization
Organization Name:CHILDREN'S BRAIN ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-222-2234
Mailing Address - Street 1:PO BOX 97876
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-7876
Mailing Address - Country:US
Mailing Address - Phone:602-222-2234
Mailing Address - Fax:866-985-7247
Practice Address - Street 1:1010 E MCDOWELL RD STE 301
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2609
Practice Address - Country:US
Practice Address - Phone:602-222-2234
Practice Address - Fax:866-985-7247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABC CHILDRENS EYE SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-02
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty