Provider Demographics
NPI:1780817627
Name:INDIVIDUALIZED PSYCHOLOGICAL RESOURCES, INC.
Entity Type:Organization
Organization Name:INDIVIDUALIZED PSYCHOLOGICAL RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KITY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LABORIEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-964-2925
Mailing Address - Street 1:7476 NW 18TH DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1008
Mailing Address - Country:US
Mailing Address - Phone:954-964-2925
Mailing Address - Fax:
Practice Address - Street 1:915 MIDDLE RIVER DR STE 307
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3560
Practice Address - Country:US
Practice Address - Phone:954-632-7260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7215103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty