MEDICARE: LISA FARALDO PHD PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist		FL

General Provider Information

NPI Number	:	1457686453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA FARALDO PHD PA

Provider Business Mailing Address
First Line	:	480 SE 1ST AVE
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-7104
Country	:	US
Telephone Number	:	954-784-8866
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 SE 1ST AVE
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-7104
Country	:	US
Telephone Number	:	954-784-8866
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LISA FARALDO
Credential	:	PHD
Telephone Number	:	954-784-8866

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	10/08/2009

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