Provider Demographics
NPI:1184886624
Name:BIRD OF PARADISE PSYCHOLOGICAL SERVICES PA
Entity type:Organization
Organization Name:BIRD OF PARADISE PSYCHOLOGICAL SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO, CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLIN
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:DONEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-720-0412
Mailing Address - Street 1:7051 W. COMMERCIAL BLVD
Mailing Address - Street 2:SUITE #3A
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2146
Mailing Address - Country:US
Mailing Address - Phone:954-720-0412
Mailing Address - Fax:954-720-0824
Practice Address - Street 1:7051 W. COMMERCIAL BLVD
Practice Address - Street 2:SUITE #3A
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-2146
Practice Address - Country:US
Practice Address - Phone:954-720-0412
Practice Address - Fax:954-720-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6151103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2173Medicare PIN