Provider Demographics
NPI:1265709521
Name:WHOLE AGAIN NEUROPSYCHOLOGY CENTER INC
Entity type:Organization
Organization Name:WHOLE AGAIN NEUROPSYCHOLOGY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENET
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-495-2130
Mailing Address - Street 1:14601 SW 29TH ST STE 101B
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4714
Mailing Address - Country:US
Mailing Address - Phone:954-933-8299
Mailing Address - Fax:
Practice Address - Street 1:14601 HOTEL ROAD
Practice Address - Street 2:SUITE 101B
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027
Practice Address - Country:US
Practice Address - Phone:954-933-8299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8359103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty