MEDICARE: E.G. PSYCHOLOGICAL SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1013641042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E.G. PSYCHOLOGICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	313 NE 2ND ST APT 1105
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1142
Country	:	US
Telephone Number	:	917-216-9638
Fax Number	:	833-478-1421

Provider Business Practice Location Address
First Line	:	313 NE 2ND ST APT 1105
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1142
Country	:	US
Telephone Number	:	917-216-9638
Fax Number	:	833-478-1421

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ESTER GOLDVARG
Credential	:	PH.D
Telephone Number	:	917-216-9638

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	07/14/2022

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