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General NPI Number Information
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NPI Number | 1083870984
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Entity Type | Organization
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Legal Business Name | PENINA FLUG, LCSW, INC.
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 10/08/2014
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Provider Practice Location Address
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Address Line | 1900 GLADES RD #352
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City | BOCA RATON
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State | FL
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Zip | 33431-7378
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Country | US
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Telephone | 561-353-7821
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Fax |
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Provider Business Mailing Address
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Address Line | 7544 ANDORRA PL
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City | BOCA RATON
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State | FL
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Zip | 33433-4958
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Country | US
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Telephone | 561-353-7821
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PENINA FLUG
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Credential | LCSW
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Telephone | 561-353-7821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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