Provider Demographics
NPI:1104016898
Name:ATLANTIC PSYCHOLOGICAL CENTER, P.C.
Entity Type:Organization
Organization Name:ATLANTIC PSYCHOLOGICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGOYA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-464-0583
Mailing Address - Street 1:12514 W ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-4085
Mailing Address - Country:US
Mailing Address - Phone:954-464-0583
Mailing Address - Fax:954-697-0275
Practice Address - Street 1:12514 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-4085
Practice Address - Country:US
Practice Address - Phone:954-464-0583
Practice Address - Fax:954-697-0275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-28
Last Update Date:2007-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6769103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty