MEDICARE: MTCA PSYCHOLOGICAL SERVICES 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	103TC0700X	Clinical Psychologist	PY8145	FL

General Provider Information

NPI Number	:	1740552322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MTCA PSYCHOLOGICAL SERVICES P.A.

Provider Business Mailing Address
First Line	:	16853 NE 2ND AVE STE 304
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-1776
Country	:	US
Telephone Number	:	786-414-6666
Fax Number	:	786-221-3542

Provider Business Practice Location Address
First Line	:	16853 NE 2ND AVE STE 304
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-1776
Country	:	US
Telephone Number	:	786-414-6666
Fax Number	:	786-221-3542

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ELIZABETH BICKNELL
Credential	:
Telephone Number	:	786-414-6666

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	02/26/2025

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