Organization
MODERN BRAIN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STELLA KARANTZOULIS PH.D. (PRESIDENT)
(646) 706-2372
Entity
Organization
Contact information
Practice address
363 7TH AVE, 11TH FLOOR, SUITE 5, NEW YORK, NY 10001-3904
(646) 706-2372
Mailing address
245 E 54TH ST, 8B, NEW YORK, NY 10022-4707
(646) 706-2372
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
017975
NY
Other
Enumeration date
01/18/2017
Last updated
01/18/2017
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