Provider Demographics
NPI:1942540257
Name:CHILD PROVIDER SPECIALISTS, INC.
Entity Type:Organization
Organization Name:CHILD PROVIDER SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED SCHOOL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-385-6292
Mailing Address - Street 1:2771 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE #5
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3642
Mailing Address - Country:US
Mailing Address - Phone:954-577-3396
Mailing Address - Fax:
Practice Address - Street 1:2771 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE #5
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3642
Practice Address - Country:US
Practice Address - Phone:954-577-3396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS480103TC1900X
FLPY5889103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty