Provider Demographics
NPI:1063422772
Name:SCZECHOWICZ, EDWARD S JR (PHD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:S
Last Name:SCZECHOWICZ
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 SW 132ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-5925
Mailing Address - Country:US
Mailing Address - Phone:305-251-3464
Mailing Address - Fax:305-251-3244
Practice Address - Street 1:8750 SW 132ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-5925
Practice Address - Country:US
Practice Address - Phone:305-251-3464
Practice Address - Fax:305-251-3244
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3369103T00000X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR99962Medicare UPIN
FL75544Medicare ID - Type Unspecified