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General NPI Number Information
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NPI Number | 1710283957
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Entity Type | Organization
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Legal Business Name | PREFERRED EDUCATIONAL & PSYCHOLOGICAL SERVICES, INC
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Dates
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Enumeration Date | 02/06/2011
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 610 SW 34TH ST SUITE 301
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City | FORT LAUDERDALE
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State | FL
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Zip | 33315-3623
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Country | US
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Telephone | 786-236-7795
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Fax |
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Provider Business Mailing Address
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Address Line | 610 SW 34TH ST SUITE 301
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City | FORT LAUDERDALE
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State | FL
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Zip | 33315-3623
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Country | US
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Telephone | 786-236-7795
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELISE SPINA TAYLOR
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Credential | PSYD
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Telephone | 786-236-7795
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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 | PY 7765
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License Number State | FL
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