Provider Demographics
NPI:1205009008
Name:AMY E DANSER PH D LLC
Entity Type:Organization
Organization Name:AMY E DANSER PH D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER (SINGLE MEMBER LLC)
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DANSER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-566-2166
Mailing Address - Street 1:915 MIDDLE RIVER DR
Mailing Address - Street 2:SUITE 307
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3544
Mailing Address - Country:US
Mailing Address - Phone:954-566-2166
Mailing Address - Fax:954-566-1186
Practice Address - Street 1:915 MIDDLE RIVER DR
Practice Address - Street 2:SUITE 307
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3544
Practice Address - Country:US
Practice Address - Phone:954-566-2166
Practice Address - Fax:954-566-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-12
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7691103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK978AMedicare UPIN