Provider Demographics
NPI:1073720835
Name:EAST LAS OLAS PSYCHOLOGICAL GROUP
Entity Type:Organization
Organization Name:EAST LAS OLAS PSYCHOLOGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL PRETE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-768-0434
Mailing Address - Street 1:108 SE 8TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2023
Mailing Address - Country:US
Mailing Address - Phone:954-768-0434
Mailing Address - Fax:954-768-0285
Practice Address - Street 1:108 SE 8TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2023
Practice Address - Country:US
Practice Address - Phone:954-768-0434
Practice Address - Fax:954-768-0285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 1856101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty