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General NPI Number Information
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NPI Number | 1780817627
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Entity Type | Organization
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Legal Business Name | INDIVIDUALIZED PSYCHOLOGICAL RESOURCES, INC.
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Dates
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Enumeration Date | 08/26/2009
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Last Update Date | 08/26/2009
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Provider Practice Location Address
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Address Line | 915 MIDDLE RIVER DR STE 307
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3560
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Country | US
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Telephone | 954-632-7260
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Fax |
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Provider Business Mailing Address
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Address Line | 7476 NW 18TH DR
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-1008
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Country | US
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Telephone | 954-964-2925
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. KITY D. LABORIEL
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Credential | PSY.D.
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Telephone | 954-964-2925
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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 | PY7215
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License Number State | FL
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