Provider Demographics
NPI:1841971181
Name:PENINSULA PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:PENINSULA PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEVENSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:571-236-3688
Mailing Address - Street 1:2234 N FEDERAL HWY
Mailing Address - Street 2:PMB #3011
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431
Mailing Address - Country:US
Mailing Address - Phone:571-236-3688
Mailing Address - Fax:
Practice Address - Street 1:550 SE 6TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483
Practice Address - Country:US
Practice Address - Phone:571-236-3688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)