Carolina Brain Wellness Center PLLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

CAROLINA BRAIN WELLNESS CENTER PLLC

Practice address

131 Charlotte Ave Ste 101B
Sanford, NC 27330-4363

Phone

(919) 205-8325

NPI assigned

Jun 17, 2020

Last updated

Jun 17, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jennifer Lynn Lundmark Richards, PH.D.NPI 1205129558

Title

Neuropsychologist

Phone

(919) 205-8325

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer L. L. Richards, PH.D.

  • Clinical Neuropsychologist
  • Sanford, NC
  • NPI 1205129558
  Medicare reassignment NPD Authorized official
• Kathleen Ratcliff, PSY.D.

  • Clinical Psychologist
  • Cary, NC
  • NPI 1154969657
  Medicare reassignment NPD

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

{
    "created_epoch": "1592352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1871119784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 CHARLOTTE AVE STE 101B",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273304363",
            "telephone_number": "919-205-8325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 CHARLOTTE AVE STE 101B",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273304363",
            "telephone_number": "919-205-8325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA BRAIN WELLNESS CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-17",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "RICHARDS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LYNN LUNDMARK",
        "authorized_official_title_or_position": "NEUROPSYCHOLOGIST",
        "authorized_official_telephone_number": "919-205-8325",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Sanford, NC
• Providers in Sanford, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.