Healthcare Provider Details

I. General information

NPI: 1972553147
Provider Name (Legal Business Name): STEVEN G SCLAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 IVES DAIRY RD BLDG 5, SUITE 138
NORTH MIAMI BEACH FL
33179-2539
US

IV. Provider business mailing address

1041 IVES DAIRY RD BLDG 5, SUITE 138
NORTH MIAMI BEACH FL
33179-2539
US

V. Phone/Fax

Practice location:
  • Phone: 305-534-5316
  • Fax: 305-538-5184
Mailing address:
  • Phone: 305-534-5316
  • Fax: 305-538-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6845
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: