Healthcare Provider Details

I. General information

NPI: 1245818053
Provider Name (Legal Business Name): MKB PSYCHOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 09/29/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WASHINGTON ST STE 304
HOLLYWOOD FL
33021-8258
US

IV. Provider business mailing address

1605 SW 108TH TER
DAVIE FL
33324-7171
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-1500
  • Fax:
Mailing address:
  • Phone: 305-778-5008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA KARILSHTADT-BYK
Title or Position: PRESIDENT
Credential: PSYD
Phone: 305-778-5008