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General NPI Number Information
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NPI Number | 1679693121
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Entity Type | Organization
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Legal Business Name | CARY R SHOOKOFF PHD PSYCHOLOGIST LLC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 12/23/2009
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Provider Practice Location Address
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Address Line | 1900 PURDY AVE STE 2 COMM. UNITS G & G
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City | MIAMI BEACH
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State | FL
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Zip | 33139-1409
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Country | US
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Telephone | 305-674-0055
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Fax | 305-341-3935
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Provider Business Mailing Address
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Address Line | 1900 PURDY AVE STE 2 COMM. UNITS G & G
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City | MIAMI BEACH
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State | FL
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Zip | 33139-1409
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Country | US
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Telephone | 305-674-0055
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Fax | 305-341-3935
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Authorized Official
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Title or Position | DIRECTOR PRESIDENT PSYCHOLOGIST
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Name | DR. CARY R SHOOKOFF
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Credential | PHD
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Telephone | 305-674-0055
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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 | PY 2924
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License Number State | FL
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