| NPI | 1205101862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER PUSHKA Owner 954-579-1110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL ME88666) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME88666) |
| 363A00000X Physician Assistant | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2012-03-15 |
| Last Update Date | 2020-08-12 |