Provider Demographics
NPI:1265512925
Name:PINES PSYCHOLOGICAL ASSOCIATES PA
Entity type:Organization
Organization Name:PINES PSYCHOLOGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-431-0411
Mailing Address - Street 1:700 N HIATUS RD
Mailing Address - Street 2:213
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-5206
Mailing Address - Country:US
Mailing Address - Phone:954-431-0411
Mailing Address - Fax:
Practice Address - Street 1:700 N HIATUS RD
Practice Address - Street 2:SUITE 213
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5206
Practice Address - Country:US
Practice Address - Phone:954-431-0411
Practice Address - Fax:954-431-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ986Medicare UPIN