Provider Demographics
NPI:1629275300
Name:CHILD PSYCHOLOGY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:CHILD PSYCHOLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:LANCELOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-668-7999
Mailing Address - Street 1:7301 SW 57TH CT STE 555
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5334
Mailing Address - Country:US
Mailing Address - Phone:305-668-7999
Mailing Address - Fax:305-668-7988
Practice Address - Street 1:7301 SW 57TH CT STE 555
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5334
Practice Address - Country:US
Practice Address - Phone:305-668-7999
Practice Address - Fax:305-668-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4882103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty