Organization
CENTER FOR BRAIN HEALTH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSICA LINDSTADT VASSALLO PHD (PRESIDENT)
(727) 669-7000
Entity
Organization
Contact information
Practice address
1840 MEASE DR, SUITE 401A, SAFETY HARBOR, FL 34695-6602
(727) 669-7000
(727) 669-7002
Mailing address
PO BOX 956, OLDSMAR, FL 34677-0956
(727) 669-7000
(727) 669-7002
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY7281
FL
103TC0700X
Clinical Psychologist
PY7281
FL
Other
Enumeration date
07/30/2006
Last updated
02/25/2008
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