Provider Demographics
NPI:1144588914
Name:IGLESIAS, ADAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:IGLESIAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 PROSPERITY FARMS RD STE C110
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3453
Mailing Address - Country:US
Mailing Address - Phone:561-775-0155
Mailing Address - Fax:
Practice Address - Street 1:11211 PROSPERITY FARMS RD STE C110
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3453
Practice Address - Country:US
Practice Address - Phone:561-775-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8522103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist