Provider Demographics
NPI:1811641715
Name:CLAG PSYCHOLOGICAL CENTER & CONSULTANTS, LLC
Entity type:Organization
Organization Name:CLAG PSYCHOLOGICAL CENTER & CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:787-593-7082
Mailing Address - Street 1:12260 GLENMORE DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7878
Mailing Address - Country:US
Mailing Address - Phone:787-593-7082
Mailing Address - Fax:
Practice Address - Street 1:12260 GLENMORE DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7878
Practice Address - Country:US
Practice Address - Phone:787-593-7082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)