Provider Demographics
NPI:1013641042
Name:E.G. PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:E.G. PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDVARG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-216-9638
Mailing Address - Street 1:313 NE 2ND ST APT 1105
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1142
Mailing Address - Country:US
Mailing Address - Phone:917-216-9638
Mailing Address - Fax:833-478-1421
Practice Address - Street 1:313 NE 2ND ST APT 1105
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1142
Practice Address - Country:US
Practice Address - Phone:917-216-9638
Practice Address - Fax:833-478-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health