Provider Demographics
NPI:1487842175
Name:PROFESSIONAL PSYCHOLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:PROFESSIONAL PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-606-5093
Mailing Address - Street 1:1108 KANE CONCOURSE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2068
Mailing Address - Country:US
Mailing Address - Phone:305-606-5093
Mailing Address - Fax:305-285-9430
Practice Address - Street 1:1108 KANE CONCOURSE
Practice Address - Street 2:SUITE 207
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2068
Practice Address - Country:US
Practice Address - Phone:305-606-5093
Practice Address - Fax:305-285-9430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6417103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty