Provider Demographics
NPI:1437427366
Name:INTEGRATIVE CENTER FOR COGNITIVE DISORDERS PA
Entity Type:Organization
Organization Name:INTEGRATIVE CENTER FOR COGNITIVE DISORDERS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-894-4802
Mailing Address - Street 1:3160 NE 210TH ST
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3634
Mailing Address - Country:US
Mailing Address - Phone:954-894-4802
Mailing Address - Fax:
Practice Address - Street 1:6100 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7900
Practice Address - Country:US
Practice Address - Phone:954-894-4802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7360103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty