Provider Demographics
NPI:1710590559
Name:GROSSE-CARDINALE, VERONICA (PSYD)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:GROSSE-CARDINALE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5525
Mailing Address - Country:US
Mailing Address - Phone:954-362-8677
Mailing Address - Fax:954-458-8167
Practice Address - Street 1:4765 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3838
Practice Address - Country:US
Practice Address - Phone:954-453-2273
Practice Address - Fax:954-458-8167
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-30
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12359103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty