Provider Demographics
NPI:1205143765
Name:PAICA-N PSYCHOLOGICAL ASSESSMENT AND INTERVENTIONS FOR CHILDREN
Entity type:Organization
Organization Name:PAICA-N PSYCHOLOGICAL ASSESSMENT AND INTERVENTIONS FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NORDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-641-3458
Mailing Address - Street 1:2645 EXECUTIVE PARK DR
Mailing Address - Street 2:504
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3624
Mailing Address - Country:US
Mailing Address - Phone:954-641-3458
Mailing Address - Fax:954-385-3303
Practice Address - Street 1:2645 EXECUTIVE PARK DR
Practice Address - Street 2:504
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3624
Practice Address - Country:US
Practice Address - Phone:954-641-3458
Practice Address - Fax:954-385-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-06
Last Update Date:2010-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7910103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1336379445OtherNPI FOR INDIVIDUAL