| Cognitive Care Pa | |
|
4565 Us Highway 17 Ste 106 Fleming Island FL 32003-4822 | |
| (904) 579-2265 | |
| Not Available |
| Full Name | Cognitive Care Pa |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 4565 Us Highway 17 Ste 106, Fleming Island, Florida |
| Authorized Official Name and Position | Christopher Rossilli (OWNER) |
| Authorized Official Contact | 9045792265 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cognitive Care Pa 10950-60 San Jose Blvd. Suite 169 Jacksonville FL 32223 Ph: (904) 770-5199 | Cognitive Care Pa 4565 Us Highway 17 Ste 106 Fleming Island FL 32003-4822 Ph: (904) 579-2265 |
| NPI Number | 1659747749 |
|---|---|
| Provider Enumeration Date | 08/12/2015 |
| Last Update Date | 06/08/2020 |
| Certification Date | 06/08/2020 |
| Medicare PECOS PAC ID | 0143539718 |
|---|---|
| Medicare Enrollment ID | O20151021002484 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659747749 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| Provider Name | Christopher M M Rossilli |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124313879 PECOS PAC ID: 2365612736 Enrollment ID: I20151030000904 |
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