Provider Demographics
NPI: | 1609172691 |
---|---|
Name: | ROSE HILL PSYCHOLOGY PA |
Entity type: | Organization |
Organization Name: | ROSE HILL PSYCHOLOGY PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | SARAJO |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FALK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD |
Authorized Official - Phone: | 954-731-0690 |
Mailing Address - Street 1: | 3410 ROSE HILL WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | LAUDERHILL |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33319-5130 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-731-0690 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3410 ROSE HILL WAY |
Practice Address - Street 2: | |
Practice Address - City: | LAUDERHILL |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33319-5130 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-731-0690 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-02-08 |
Last Update Date: | 2011-02-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | PY5737 | 103TC0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Single Specialty |