Provider Demographics
NPI:1265459275
Name:CENTER FOR CLINICAL & FORENSIC PSYCHOLOGY INC
Entity Type:Organization
Organization Name:CENTER FOR CLINICAL & FORENSIC PSYCHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JO-ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-584-6155
Mailing Address - Street 1:624 W TROPICAL WAY
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3348
Mailing Address - Country:US
Mailing Address - Phone:954-584-6155
Mailing Address - Fax:954-316-7553
Practice Address - Street 1:624 W TROPICAL WAY
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3348
Practice Address - Country:US
Practice Address - Phone:954-584-6155
Practice Address - Fax:954-316-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5318103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1726Medicare ID - Type Unspecified