Provider Demographics
NPI:1518033323
Name:COGNITIVE DISSONANCE INC
Entity Type:Organization
Organization Name:COGNITIVE DISSONANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-981-3200
Mailing Address - Street 1:5324 HAYES STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-981-3200
Mailing Address - Fax:423-790-1620
Practice Address - Street 1:4800 SW 64TH AVE
Practice Address - Street 2:SUITE 105-D
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4429
Practice Address - Country:US
Practice Address - Phone:954-981-3200
Practice Address - Fax:423-790-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW891041C0700X
FLMT58106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4485AMedicare PIN
FLZ4485BMedicare PIN
FLZ4485CMedicare PIN