Healthcare Provider Details

I. General information

NPI: 1306133244
Provider Name (Legal Business Name): EXPERT PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 NW PRIMA VISTA BLVD
PORT SAINT LUCIE FL
34983-8731
US

IV. Provider business mailing address

447 NW PRIMA VISTA BLVD
PORT SAINT LUCIE FL
34983-8731
US

V. Phone/Fax

Practice location:
  • Phone: 772-249-2593
  • Fax:
Mailing address:
  • Phone: 772-249-2593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY8016
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY8016
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE ZAKY
Title or Position: PSYCHOLOGIST/PRESIDENT
Credential: PSY.D.
Phone: 772-249-2593