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General NPI Number Information
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NPI Number | 1871755579
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Entity Type | Organization
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Legal Business Name | GLENN R CADDY PHD PA
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 3101 N FEDERAL HWY SUITE 301
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City | FT LAUDERDALE
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State | FL
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Zip | 33306-1018
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Country | US
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Telephone | 954-565-8850
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Fax |
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Provider Business Mailing Address
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Address Line | 3101 N FEDERAL HWY SUITE 301
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City | FT LAUDERDALE
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State | FL
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Zip | 33306-1018
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Country | US
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Telephone | 954-565-8850
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GLENN ROSS CADDY
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Credential | PH.D.
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Telephone | 954-565-8850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | PY2093
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License Number State | FL
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