Provider Demographics
NPI:1467607960
Name:BROWARD PSYCHOLOGICAL GROUP INC
Entity Type:Organization
Organization Name:BROWARD PSYCHOLOGICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:GRADITOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-961-5447
Mailing Address - Street 1:4400 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3514
Mailing Address - Country:US
Mailing Address - Phone:954-961-5447
Mailing Address - Fax:
Practice Address - Street 1:4400 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3514
Practice Address - Country:US
Practice Address - Phone:954-961-5447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY002243103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75057Medicare UPIN