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General NPI Number Information
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NPI Number | 1518054998
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL MEDICINE & BIOFEEDBACK CONSULTANTS INC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 03/30/2016
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Provider Practice Location Address
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Address Line | 150 SW 12TH AVE SUITE #330
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City | POMPANO BEACH
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State | FL
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Zip | 33069-3298
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Country | US
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Telephone | 954-783-5100
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Fax | 954-783-5176
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Provider Business Mailing Address
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Address Line | 150 SW 12TH AVE SUITE #330
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City | POMPANO BEACH
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State | FL
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Zip | 33069-3298
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Country | US
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Telephone | 954-783-5100
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Fax | 954-783-5176
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GARY S. TRAUB
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Credential | PH.D.
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Telephone | 954-783-5100
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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 | PY3620
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7394
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License Number State | FL
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