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NPI Code Detail

MEDICARE: PALM COVE PSYCHOLOGY GROUP, PLLC

MEDICARE: PALM COVE PSYCHOLOGY GROUP, 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
1103TA0400XAddiction (Substance Use Disorder) Psychologist
2103TB0200XCognitive & Behavioral Psychologist
3103TC2200XClinical Child & Adolescent Psychologist
4103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1891394755
Entity Type Code : Organization
Provider Name (Legal Business Name) : PALM COVE PSYCHOLOGY GROUP, PLLC
Provider Business Mailing Address
First Line : 1500 GATEWAY BLVD STE 220
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33426-7233
Country : US
Telephone Number : 561-903-0078
Fax Number : 561-903-0079
Provider Business Practice Location Address
First Line : 1500 GATEWAY BLVD STE 220
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33426-7233
Country : US
Telephone Number : 561-903-0078
Fax Number : 561-903-0079
Authorized Official
Title or Position : LICENSED PSYCHOLOGIST
Name : DR. ANDREA HANLEY
Credential : PH.D.
Telephone Number : 561-903-0078
Provider Enumeration Date : 10/21/2020
Last Update Date : 10/21/2020

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