MEDICARE: PEDIATRIC PSYCHSOLUTIONS, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	SS 1122	FL

General Provider Information

NPI Number	:	1275968273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PSYCHSOLUTIONS, P.A.

Provider Business Mailing Address
First Line	:	2200 N COMMERCE PKWY
Second Line	:	SUITE 200
City	:	WESTON
State	:	FL
Zip	:	33326-3258
Country	:	US
Telephone Number	:	954-842-3643
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 N COMMERCE PKWY
Second Line	:	SUITE 200
City	:	WESTON
State	:	FL
Zip	:	33326-3258
Country	:	US
Telephone Number	:	954-842-3643
Fax Number	:

Authorized Official
Title or Position	:	LICENSED SCHOOL PSYCHOLOGIST
Name	:	MRS. NADINE CHARLES DE GIORDANY
Credential	:	PSY. S., MSW
Telephone Number	:	305-206-9166

Provider Enumeration Date	:	09/09/2013
Last Update Date	:	09/09/2013

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