Healthcare Provider Details

I. General information

NPI: 1346521424
Provider Name (Legal Business Name): CHILDREN'S EDUCATIONAL & PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2883 EXECUTIVE PARK DR SUITE 103 F
WESTON FL
33331-3662
US

IV. Provider business mailing address

2883 EXECUTIVE PARK DR SUITE 103 F
WESTON FL
33331-3662
US

V. Phone/Fax

Practice location:
  • Phone: 954-579-6949
  • Fax: 754-223-7123
Mailing address:
  • Phone: 954-579-6949
  • Fax: 754-223-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberSS 989
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberSS 989
License Number StateFL

VIII. Authorized Official

Name: MR. DAVID KRASKY
Title or Position: LEAD PSYCHOLOGIST
Credential: PSY.S.
Phone: 954-579-6949