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General NPI Number Information
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NPI Number | 1811178387
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Entity Type | Organization
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Legal Business Name | RIVERSIDE PSYCHOLOGICAL GROUP
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 1801 UNIVERSITY DRIVE PENTHOUSE A
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City | CORAL SPRINGS
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State | FL
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Zip | 33071
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Country | US
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Telephone | 954-755-4778
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Fax | 954-755-0240
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Provider Business Mailing Address
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Address Line | 1801 UNIVERSITY DRIVE PENTHOUSE SUITE A
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City | CORAL SPRINGS
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State | FL
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Zip | 33071
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Country | US
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Telephone | 954-755-4778
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Fax | 954-755-0240
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. JOSEPH JOHN CIMINO
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Credential | PSYD
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Telephone | 954-755-4778
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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 | PY4734
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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 | PY0004734
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License Number State | FL
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