Healthcare Provider Details

I. General information

NPI: 1396955894
Provider Name (Legal Business Name): A & B PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 BAYVIEW DR
FT LAUDERDALE FL
33308
US

IV. Provider business mailing address

5151 BAYVIEW DR
FT LAUDERDALE FL
33308
US

V. Phone/Fax

Practice location:
  • Phone: 954-491-6984
  • Fax: 954-491-7068
Mailing address:
  • Phone: 954-491-6984
  • Fax: 954-491-7068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY3271
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY2027
License Number StateFL

VIII. Authorized Official

Name: DR. VICTORIA B AZRIN
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 954-491-6984