Provider Demographics
NPI: | 1548604028 |
---|---|
Name: | PSYCHOLOGY & BEYOND, INC |
Entity type: | Organization |
Organization Name: | PSYCHOLOGY & BEYOND, INC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PSYCHOLOGIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | FRANK |
Authorized Official - Middle Name: | ROBERTO |
Authorized Official - Last Name: | PEREZ VERDECIA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PSYD, LMHC, BCBA |
Authorized Official - Phone: | 305-917-5414 |
Mailing Address - Street 1: | 2020 PONCE DE LEON BLVD STE 1201 |
Mailing Address - Street 2: | |
Mailing Address - City: | CORAL GABLES |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33134-4476 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-917-5414 |
Mailing Address - Fax: | 305-220-1864 |
Practice Address - Street 1: | 2020 PONCE DE LEON BLVD STE 1201 |
Practice Address - Street 2: | |
Practice Address - City: | CORAL GABLES |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33134-4476 |
Practice Address - Country: | US |
Practice Address - Phone: | 305-917-5414 |
Practice Address - Fax: | 305-220-1864 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-04-26 |
Last Update Date: | 2024-08-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | PY8713 | 101YP2500X, 103T00000X, 103G00000X, 103K00000X, 103TB0200X, 103TC2200X, 103TM1800X, 103TR0400X, 103TS0200X, 225C00000X, 222Q00000X, 103TC0700X |
FL | MH10722 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Single Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Single Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Single Specialty | |
No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Single Specialty | |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Single Specialty | |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Single Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Single Specialty |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Single Specialty |
No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | Group - Single Specialty |
No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School | Group - Single Specialty |
No | 225C00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Group - Single Specialty | |
No | 222Q00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 017755200 | Medicaid |