| NPI | 1285938282 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATOYA E SHAKES MALONE Manager 954-583-4568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY7376) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY7376) |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2011-01-05 |