Provider Demographics
NPI:1861583452
Name:ACADIA PSYCHOLOGICAL SERVICES PA
Entity type:Organization
Organization Name:ACADIA PSYCHOLOGICAL SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-368-9940
Mailing Address - Street 1:7301 W PALMETTO PARK RD
Mailing Address - Street 2:STE. 204A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3458
Mailing Address - Country:US
Mailing Address - Phone:561-368-9940
Mailing Address - Fax:561-368-3255
Practice Address - Street 1:7301 W PALMETTO PARK RD
Practice Address - Street 2:STE. 204A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3458
Practice Address - Country:US
Practice Address - Phone:561-368-9940
Practice Address - Fax:561-368-3255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6755101YM0800X
FLPY5025103T00000X, 103G00000X
FLPY6368103T00000X
FLSW69621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59508Medicare ID - Type UnspecifiedFL MEDICARE #