Provider Demographics
NPI:1740552322
Name:MTCA PSYCHOLOGICAL SERVICES P.A.
Entity type:Organization
Organization Name:MTCA PSYCHOLOGICAL SERVICES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BICKNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-414-6666
Mailing Address - Street 1:16853 NE 2ND AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1776
Mailing Address - Country:US
Mailing Address - Phone:786-414-6666
Mailing Address - Fax:786-221-3542
Practice Address - Street 1:16853 NE 2ND AVE STE 304
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1776
Practice Address - Country:US
Practice Address - Phone:786-414-6666
Practice Address - Fax:786-221-3542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8145103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty