Provider Demographics
NPI:1598890659
Name:JC PSYCHOLOGICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:JC PSYCHOLOGICAL ASSOCIATES INC
Other - Org Name:ADAPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CIAVARELLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-589-0162
Mailing Address - Street 1:9700 STIRLING RD STE 105B
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-8011
Mailing Address - Country:US
Mailing Address - Phone:954-589-0162
Mailing Address - Fax:954-212-6100
Practice Address - Street 1:9700 STIRLING RD STE 105B
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8011
Practice Address - Country:US
Practice Address - Phone:954-589-0162
Practice Address - Fax:954-212-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7114103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8357Medicare PIN
FL75067ZMedicare UPIN