Mind and Brain Care LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PY7375 Issued in FL

Legal business name

MIND AND BRAIN CARE LLC

Practice address

10175 6 Mile Cypress Pkwy Ste 3
Fort Myers, FL 33966-6993

Phone

(239) 768-6500

NPI assigned

Aug 30, 2010

Last updated

Dec 11, 2023By 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. Mabel Lopez, PHDNPI 1508971037

Title

Owner

Phone

(239) 768-6500

Specialties & licenses 7

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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.

• Mabel Lopez, PH.D.

  • Clinical Neuropsychologist
  • Fort Myers, FL
  • NPI 1508971037
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1283126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702252800000",
    "number": "1942516844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10175 6 MILE CYPRESS PKWY",
            "address_2": "SUITE 3",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339669663",
            "telephone_number": "239-768-6500",
            "fax_number": "239-768-6421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10175 6 MILE CYPRESS PKWY STE 3",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339666993",
            "telephone_number": "239-768-6500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6442 Commerce Park Dr",
            "address_2": "Suite 1",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339664723",
            "country_code": "US",
            "telephone_number": "239-768-6500",
            "fax_number": "239-768-6421",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2804 Del Prado Blvd S Ste 102",
            "address_purpose": "LOCATION",
            "city": "Cape Coral",
            "state": "FL",
            "postal_code": "339047227",
            "country_code": "US",
            "telephone_number": "239-768-6500",
            "fax_number": "239-768-6500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIND AND BRAIN CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-30",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "MABEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-768-6500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "FL",
            "license": "PY7375",
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "FL",
            "license": "PY7375",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY7375",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "FL",
            "license": "PY7375",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "FL",
            "license": "PY7375",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Forensic",
            "state": "FL",
            "license": "PY7375",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "FL",
            "license": "PY7375",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "75725",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6022640",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon Leigh Mims
• Steven C Mims, CRNA
• Bassem M Mina
• John W Mina, DPM
• Cecilia Minano, M.D., M.P.H.
• Mindful Journey Therapy LLC
• Moira V. Miner, RN
• Dana Dale Minick
• Robert Keith Minkes, M.D.
• Ashley Marie Minor, PA

• Clinical Neuropsychologist in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Clinical Neuropsychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; 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.