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General NPI Number Information
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NPI Number | 1366988610
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Entity Type | Organization
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Legal Business Name | BEACH CITIES PSYCHOLOGICAL CLINIC, INC.
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 13555 SE 93RD COURT RD
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City | SUMMERFIELD
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State | FL
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Zip | 34491-9459
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Country | US
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Telephone | 949-813-8180
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Fax | 224-365-3488
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Provider Business Mailing Address
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Address Line | 13555 SE 93RD COURT RD
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City | SUMMERFIELD
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State | FL
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Zip | 34491-9459
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Country | US
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Telephone | 949-813-8180
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. EILEEN M KRAMER
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Credential | PSYD
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Telephone | 949-813-8180
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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 | PSY25548
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License Number State | CA
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