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General NPI Number Information
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NPI Number | 1306068622
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Entity Type | Organization
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Legal Business Name | EAST LAS OLAS PSYCHOLOGICAL GROUP
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 108 SE 8TH AVENUE, SUITE 203
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City | FORT LAUDERDALE
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State | FL
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Zip | 33140
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Country | US
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Telephone | 954-768-0434
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Fax | 954-768-0285
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Provider Business Mailing Address
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Address Line | 108 SE 8TH AVENUE, SUITE 203
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City | FORT LAUDERDALE
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State | FL
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Zip | 33140
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Country | US
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Telephone | 954-768-0434
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Fax | 954-768-0285
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD P DEL PRETE
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Credential | LMHC
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Telephone | 964-768-0434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MENTAL HEALTH 1856
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License Number State | FL
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