Provider Demographics
NPI:1922360114
Name:BETH HERSHKOWITZ HALL, PH.D., P.A.
Entity Type:Organization
Organization Name:BETH HERSHKOWITZ HALL, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:HERSHKOWITZ
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-772-6677
Mailing Address - Street 1:6499 POWERLINE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2069
Mailing Address - Country:US
Mailing Address - Phone:954-772-6677
Mailing Address - Fax:954-772-6711
Practice Address - Street 1:6499 POWERLINE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2069
Practice Address - Country:US
Practice Address - Phone:954-772-6677
Practice Address - Fax:954-772-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4560103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73834Medicare PIN