Healthcare Provider Details

I. General information

NPI: 1629049390
Provider Name (Legal Business Name): FAMILY AND FORENSIC PSYCHOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 STIRLING RD STE 6
COOPER CITY FL
33024
US

IV. Provider business mailing address

10000 STIRLING RD STE 6
COOPER CITY FL
33024
US

V. Phone/Fax

Practice location:
  • Phone: 954-436-8326
  • Fax: 954-433-0603
Mailing address:
  • Phone: 954-436-8326
  • Fax: 954-433-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0004966
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY0004966
License Number StateFL

VIII. Authorized Official

Name: DR. CHARLES BARRY WINICK
Title or Position: PRESIDENT
Credential: PSY D
Phone: 954-436-8326