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General NPI Number Information
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NPI Number | 1811190978
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Entity Type | Organization
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Legal Business Name | HOLLYWOOD PSYCHOLOGY CENTER INC.
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 3595 SHERIDAN ST #103
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3657
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Country | US
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Telephone | 954-981-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 3595 SHERIDAN ST #103
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3657
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Country | US
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Telephone | 954-981-8200
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ANDREW S GAST
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Credential | PSY.D.
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Telephone | 954-981-8200
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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 | PY7707
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License Number State | FL
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