| The Brain Spa, Llc | |
|
210 Jupiter Lakes Blvd Ste 3102 Jupiter FL 33458 | |
| (561) 406-6561 | |
| (561) 406-6629 |
| Full Name | The Brain Spa, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 210 Jupiter Lakes Blvd Ste 3102, Jupiter, Florida |
| Authorized Official Name and Position | Edward Leonardo Barias (MEDICAL DIRECTOR/OWNER) |
| Authorized Official Contact | 5614066561 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Brain Spa, Llc 210 Jupiter Lakes Blvd Ste 3102 Jupiter FL 33458-7189 Ph: (561) 406-6561 | The Brain Spa, Llc 210 Jupiter Lakes Blvd Ste 3102 Jupiter FL 33458 Ph: (561) 406-6561 |
| NPI Number | 1063907517 |
|---|---|
| Provider Enumeration Date | 06/27/2018 |
| Last Update Date | 08/30/2018 |
| Medicare PECOS PAC ID | 1557616182 |
|---|---|
| Medicare Enrollment ID | O20190723000749 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063907517 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0802X | Psychiatry & Neurology - Addiction Psychiatry | ME119718 (Florida) | Primary |
| Provider Name | Linda G Morris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760517684 PECOS PAC ID: 6406981745 Enrollment ID: I20100311001073 |
| Provider Name | Jennifer A Bruk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770989923 PECOS PAC ID: 1557680519 Enrollment ID: I20150425000106 |
| Provider Name | Edward L Barias |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689007700 PECOS PAC ID: 5890925960 Enrollment ID: I20180702002385 |
| Provider Name | Allison Lelania Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750979373 PECOS PAC ID: 9032525548 Enrollment ID: I20210309000078 |
| Provider Name | Jeffry R Nurenberg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144396086 PECOS PAC ID: 8224016076 Enrollment ID: I20220616002469 |
| Provider Name | Dahiana S Rafailovitc |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447950993 PECOS PAC ID: 2961869375 Enrollment ID: I20230530003021 |
| Provider Name | Zachory T Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518661388 PECOS PAC ID: 1557720927 Enrollment ID: I20230703000618 |
| Provider Name | Joanna L Peros |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588146930 PECOS PAC ID: 6305207739 Enrollment ID: I20230802001234 |
| Provider Name | Nina S Chaitin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295310647 PECOS PAC ID: 4082063946 Enrollment ID: I20231218002565 |
| Provider Name | Shirley K Schulte |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043090004 PECOS PAC ID: 8921441239 Enrollment ID: I20240202003360 |
| Provider Name | Amanda M Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891476966 PECOS PAC ID: 4880039981 Enrollment ID: I20240228003474 |
| Provider Name | Kai M Johnson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1316038805 PECOS PAC ID: 1951746916 Enrollment ID: I20240229001012 |
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