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General NPI Number Information
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NPI Number | 1891936225
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Entity Type | Organization
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Legal Business Name | ELIZABETH LAQUIDARA PHD PA
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 7025 BERACASA WAY 102 B
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City | BOCA RATON
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State | FL
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Zip | 33433-3443
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Country | US
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Telephone | 561-416-7338
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Fax |
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Provider Business Mailing Address
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Address Line | 7025 BERACASA WAY STE 102B
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City | BOCA RATON
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State | FL
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Zip | 33433-3428
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Country | US
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Telephone | 561-416-7338
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. ELIZABETH LAQUIDARA
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Credential | PHD
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Telephone | 561-416-1008
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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 | PY5164
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License Number State | FL
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