10D2172726 CLIA NUMBER - THE BRAIN SPA, LLC

Laboratory Demographics

CLIA Number: 10D2172726

Facility Name: THE BRAIN SPA, LLC

Facility Address:
210 JUPITER LAKES BLVD BLDG 300 SUITE 102
JUPITER, FL
ZIP 33458
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Facility Phone Number: 561 406-6561

Facility Type: Other - SUBSTANCE ABUSE FACILITY

Certificate Type: Waiver

NPI Number: 1063907517

Taxonomy: 2084P0802X - Psychiatry & Neurology
Addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders.

CLIA Record

Field Name	Field Value
CLIA Number	10D2172726
LAB Type	Other - SUBSTANCE ABUSE FACILITY
Facility Name	THE BRAIN SPA, LLC
Street	210 JUPITER LAKES BLVD BLDG 300 SUITE 102
City	JUPITER
State	FL
ZIP	33458
Phone	561 406-6561
CertificateType	4
CertificateEffectiveDate	9/30/2023
CertificateExpirationDate	9/29/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024