Provider Demographics
NPI:1932373800
Name:PSYCHOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:PSYCHOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:CANDACE
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-987-8812
Mailing Address - Street 1:3900 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6760
Mailing Address - Country:US
Mailing Address - Phone:954-987-8812
Mailing Address - Fax:954-987-2615
Practice Address - Street 1:3900 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6760
Practice Address - Country:US
Practice Address - Phone:954-987-8812
Practice Address - Fax:954-987-2615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty