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General NPI Number Information
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NPI Number | 1184886624
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Entity Type | Organization
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Legal Business Name | BIRD OF PARADISE PSYCHOLOGICAL SERVICES PA
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 7051 W. COMMERCIAL BLVD SUITE #3A
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City | TAMARAC
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State | FL
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Zip | 33319-2146
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Country | US
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Telephone | 954-720-0412
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Fax | 954-720-0824
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Provider Business Mailing Address
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Address Line | 7051 W. COMMERCIAL BLVD SUITE #3A
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City | TAMARAC
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State | FL
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Zip | 33319-2146
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Country | US
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Telephone | 954-720-0412
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Fax | 954-720-0824
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Authorized Official
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Title or Position | OWNER, CEO, CFO
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Name | DR. KARLIN ANTOINETTE DONEGAL
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Credential | PH.D.
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Telephone | 954-720-0412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6151
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License Number State | FL
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