Provider Demographics
NPI:1992862825
Name:CIMINO, JOSEPH JOHN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:CIMINO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8914
Mailing Address - Country:US
Mailing Address - Phone:954-755-4778
Mailing Address - Fax:954-755-0240
Practice Address - Street 1:1500 N UNIVERSITY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8914
Practice Address - Country:US
Practice Address - Phone:954-755-4778
Practice Address - Fax:954-755-0240
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004734103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73993SMedicare UPIN