| Entity Name: | FLORIDA NEUROPSYCHOLOGY GROUP PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 29 Jul 2022 (3 years ago) |
| Document Number: | P22000060417 |
| FEI/EIN Number | 921163564 |
| Address: | 1860 82ND AVE, 201, VERO BEACH, FL, 32966, US |
| Mail Address: | 1860 82ND AVE, 201, VERO BEACH, FL, 32966, US |
| ZIP code: | 32966 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205559028 | 2022-09-26 | 2022-11-29 | 1860 82ND AVE STE 201, VERO BEACH, FL, 329666998, US | 1860 82ND AVE STE 201, VERO BEACH, FL, 329666998, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 772-365-4934 |
| Fax | 7723626901 |
Authorized person
| Name | LAURA ANNETTE ADAMS |
| Role | NEUROPSYCHOLOGIST/PSYCHOLOGIST/PRES |
| Phone | 7723654934 |
Taxonomy
| Taxonomy Code | 101Y00000X - Counselor |
| Is Primary | No |
| Taxonomy Code | 103G00000X - Clinical Neuropsychologist |
| Is Primary | Yes |
| Taxonomy Code | 103T00000X - Psychologist |
| Is Primary | No |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | No |
| Taxonomy Code | 103TP2701X - Group Psychotherapy Psychologist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | INDIVIDUAL NPI |
| Number | 1750851887 |
| Name | Role | Address |
|---|---|---|
| ADAMS LAURA A | Agent | 1120 QUESADA ST SE, PALM BAY, FL, 32909 |
| Name | Role | Address |
|---|---|---|
| ADAMS LAURA A | President | 1860 82ND AVE, STE 201, VERO BEACH, FL, 329666998 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-11 |
| ANNUAL REPORT | 2023-04-27 |
| Domestic Profit | 2022-07-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
