Provider Demographics
NPI:1619048600
Name:AIDA L ANDERS PSY D PA
Entity Type:Organization
Organization Name:AIDA L ANDERS PSY D PA
Other - Org Name:AIDA L ANDERS PSY D
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-632-2409
Mailing Address - Street 1:9000 SHERIDAN ST STE 98
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-8802
Mailing Address - Country:US
Mailing Address - Phone:954-632-2409
Mailing Address - Fax:954-538-0075
Practice Address - Street 1:9000 SHERIDAN ST STE 98
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-8802
Practice Address - Country:US
Practice Address - Phone:954-632-2409
Practice Address - Fax:954-538-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6410103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
73072OtherPIN FOR BCBS
73072OtherPIN FOR BCBS