Smart Brain Aging Inc

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

4026 Issued in AZ

Legal business name

SMART BRAIN AGING INC

Practice address

7878 N 16TH St
Suite 250
Phoenix, AZ 85020-4449

Phone

(602) 395-0715

Fax

(602) 277-8146

NPI assigned

May 20, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John M Denboer, PHD

Title

President

Phone

(480) 861-0020

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463702400000",
    "number": "1184071086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 N GATEWAY DR",
            "address_2": "SUITE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850341700",
            "telephone_number": "185-527-6278",
            "fax_number": "602-277-8146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7878 N 16TH ST",
            "address_2": "SUITE 250",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850204449",
            "telephone_number": "602-395-0715",
            "fax_number": "602-277-8146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMART BRAIN AGING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-20",
        "last_updated": "2016-05-20",
        "status": "A",
        "authorized_official_last_name": "DENBOER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-861-0020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "AZ",
            "license": "4026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Lynn Smalley, FNP-C
• Shannon Hillman Smalley, DO
• Erin Nicole Smallmon, DO
• Rachel S Smallwood, PHARMD
• Christina Marie Smarik Snyder, MD
• Smart Home Care LLC
• Smart Start Autism Therapy Center LLC
• Smart Trans LLC
• Latoya Smart
• Michael W Smart, PH.D.

• Clinical Neuropsychologist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Clinical Neuropsychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.