Provider Demographics
NPI:1306236294
Name:THE BRAIN BOOSTERS, INC.
Entity type:Organization
Organization Name:THE BRAIN BOOSTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF LEARNING & DEVELOPMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-870-3737
Mailing Address - Street 1:333 JERICHO TPKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1100
Mailing Address - Country:US
Mailing Address - Phone:516-870-3737
Mailing Address - Fax:732-964-9446
Practice Address - Street 1:333 JERICHO TPKE
Practice Address - Street 2:SUITE 200
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1100
Practice Address - Country:US
Practice Address - Phone:516-870-3737
Practice Address - Fax:732-964-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health