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General NPI Number Information
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NPI Number | 1801152616
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Entity Type | Organization
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Legal Business Name | A DIFFERENT PERSPECTIVE, LLC
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 17900 NW 5TH ST SUITE 201
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-2808
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Country | US
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Telephone | 954-494-6813
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Fax |
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Provider Business Mailing Address
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Address Line | 17900 NW 5TH ST SUITE 201
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-2808
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Country | US
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Telephone | 954-494-6813
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. RAFAEL J BOTTA JR.
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Credential | PSY.D.
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Telephone | 954-494-6813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PY7746
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License Number State | FL
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