Provider Demographics
NPI:1487896106
Name:BRAIN RESOURCE NETWORK LLC
Entity type:Organization
Organization Name:BRAIN RESOURCE NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-592-9913
Mailing Address - Street 1:2828 CASA ALOMA WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2223
Mailing Address - Country:US
Mailing Address - Phone:407-592-9913
Mailing Address - Fax:407-386-6085
Practice Address - Street 1:2828 CASA ALOMA WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2223
Practice Address - Country:US
Practice Address - Phone:407-592-9913
Practice Address - Fax:407-386-6085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty