Healthcare Provider Details

I. General information

NPI: 1285938282
Provider Name (Legal Business Name): POSITIVE SOLUTIONS PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 NW 5TH ST SUITE 207
PLANTATION FL
33317-2120
US

IV. Provider business mailing address

4121 NW 5TH ST SUITE 207
PLANTATION FL
33317-2120
US

V. Phone/Fax

Practice location:
  • Phone: 954-583-4568
  • Fax: 954-583-4528
Mailing address:
  • Phone: 954-583-4568
  • Fax: 954-583-4528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY7376
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7376
License Number StateFL

VIII. Authorized Official

Name: DR. LATOYA E SHAKES MALONE
Title or Position: MANAGER
Credential: PH.D.
Phone: 954-583-4568