Provider Demographics
NPI:1811190978
Name:HOLLYWOOD PSYCHOLOGY CENTER INC.
Entity Type:Organization
Organization Name:HOLLYWOOD PSYCHOLOGY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:GAST
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-981-8200
Mailing Address - Street 1:3595 SHERIDAN ST
Mailing Address - Street 2:#103
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3657
Mailing Address - Country:US
Mailing Address - Phone:954-981-8200
Mailing Address - Fax:
Practice Address - Street 1:3595 SHERIDAN ST
Practice Address - Street 2:#103
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3657
Practice Address - Country:US
Practice Address - Phone:954-981-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7707103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AG881Medicare UPIN