Provider Demographics
NPI:1386393544
Name:THE BRAIN SPA CONCIERGE PA
Entity type:Organization
Organization Name:THE BRAIN SPA CONCIERGE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-406-6561
Mailing Address - Street 1:210 JUPITER LAKES BLVD STE 4104
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7190
Mailing Address - Country:US
Mailing Address - Phone:561-406-6561
Mailing Address - Fax:561-406-6629
Practice Address - Street 1:210 JUPITER LAKES BLVD STE 4104
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7190
Practice Address - Country:US
Practice Address - Phone:561-406-6561
Practice Address - Fax:561-406-6629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty