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General NPI Number Information
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NPI Number | 1154594547
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL SPECIALISTS PA
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 7000 SW 62ND AVE PH L
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4721
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Country | US
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Telephone | 305-667-4724
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Fax | 305-667-8599
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Provider Business Mailing Address
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Address Line | 7000 SW 62ND AVE PH L
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4721
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Country | US
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Telephone | 305-667-4724
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Fax | 305-667-8599
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEONARD I JACOBSON
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Credential | PH.D.
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Telephone | 305-667-4724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | FL PY0002309
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License Number State | FL
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