Provider Demographics
NPI:1962928457
Name:CENTER FOR BRAIN HEALTH PLLC
Entity type:Organization
Organization Name:CENTER FOR BRAIN HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:617-855-7288
Mailing Address - Street 1:1101 BEACON ST STE 8W
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5587
Mailing Address - Country:US
Mailing Address - Phone:617-855-7288
Mailing Address - Fax:
Practice Address - Street 1:1101 BEACON ST STE 8W
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5587
Practice Address - Country:US
Practice Address - Phone:617-855-7288
Practice Address - Fax:860-783-5590
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY WEIGHT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-17
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1201X, 2084B0002X
MA2699362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty
No2084B0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyObesity MedicineGroup - Multi-Specialty