MEDICARE: POSITIVE SOLUTIONS PSYCHOLOGICAL SERVICES, PLLC

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	103TC0700X	Clinical Psychologist	PY7376	FL
2	103T00000X	Psychologist	PY7376	FL

General Provider Information

NPI Number	:	1285938282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE SOLUTIONS PSYCHOLOGICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	4121 NW 5TH ST
Second Line	:	SUITE 207
City	:	PLANTATION
State	:	FL
Zip	:	33317-2120
Country	:	US
Telephone Number	:	954-583-4568
Fax Number	:	954-583-4528

Provider Business Practice Location Address
First Line	:	4121 NW 5TH ST
Second Line	:	SUITE 207
City	:	PLANTATION
State	:	FL
Zip	:	33317-2120
Country	:	US
Telephone Number	:	954-583-4568
Fax Number	:	954-583-4528

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. LATOYA E SHAKES MALONE
Credential	:	PH.D.
Telephone Number	:	954-583-4568

Provider Enumeration Date	:	01/05/2011
Last Update Date	:	01/05/2011

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