Provider Demographics
NPI:1891936225
Name:ELIZABETH LAQUIDARA PHD PA
Entity Type:Organization
Organization Name:ELIZABETH LAQUIDARA PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAQUIDARA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-416-1008
Mailing Address - Street 1:7025 BERACASA WAY STE 102B
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3428
Mailing Address - Country:US
Mailing Address - Phone:561-416-7338
Mailing Address - Fax:
Practice Address - Street 1:7025 BERACASA WAY
Practice Address - Street 2:102 B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3443
Practice Address - Country:US
Practice Address - Phone:561-416-7338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5164103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBS170Medicare PIN