Provider Demographics
NPI:1306026604
Name:PSYCHOLOGICAL ASSOCIATES OF THE PALM BEACHES INC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL ASSOCIATES OF THE PALM BEACHES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COSTANZA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:561-279-9295
Mailing Address - Street 1:3692 MOON BAY CIR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8806
Mailing Address - Country:US
Mailing Address - Phone:561-279-9295
Mailing Address - Fax:561-333-8029
Practice Address - Street 1:1300 NW 17TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2554
Practice Address - Country:US
Practice Address - Phone:561-279-9295
Practice Address - Fax:561-333-8029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5739103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty