Healthcare Provider Details

I. General information

NPI: 1346423035
Provider Name (Legal Business Name): LAURIE NITZBERG SABRA PHD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 SHERIDAN ST SUITE 400
HOLLYWOOD FL
33021-3409
US

IV. Provider business mailing address

4600 SHERIDAN ST SUITE 400
HOLLYWOOD FL
33021-3409
US

V. Phone/Fax

Practice location:
  • Phone: 954-989-3600
  • Fax: 954-894-1884
Mailing address:
  • Phone: 954-989-3600
  • Fax: 954-894-1884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. MICHELLE GINSBERG
Title or Position: PRACTICE LIAISON
Credential:
Phone: 954-989-3600