Organization
CENTER FOR BRAIN HEALTH INC
Active
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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