Provider Demographics
NPI:1760208714
Name:THE NEUROFEEDBACK INSTITUTE, PA
Entity type:Organization
Organization Name:THE NEUROFEEDBACK INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REGLA
Authorized Official - Middle Name:JOSEFINA
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-785-6610
Mailing Address - Street 1:1416 SANTA CRUZ AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2258
Mailing Address - Country:US
Mailing Address - Phone:305-785-6610
Mailing Address - Fax:954-389-7600
Practice Address - Street 1:1605 TOWN CENTER BLVD STE D
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3637
Practice Address - Country:US
Practice Address - Phone:786-505-2485
Practice Address - Fax:954-389-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1881961001OtherINDIVIDUAL NPI