Provider Demographics
NPI:1760864219
Name:ADDYS PRIETO PSYD PA
Entity Type:Organization
Organization Name:ADDYS PRIETO PSYD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADDYS
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-802-0758
Mailing Address - Street 1:1601 N PALM AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3200
Mailing Address - Country:US
Mailing Address - Phone:954-802-0758
Mailing Address - Fax:954-252-5360
Practice Address - Street 1:1601 N PALM AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3200
Practice Address - Country:US
Practice Address - Phone:954-802-0758
Practice Address - Fax:954-252-5360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 5686103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0310Medicare UPIN