Provider Demographics
NPI:1104670256
Name:BOCA RATON PSYCHOLOGY GROUP PA
Entity type:Organization
Organization Name:BOCA RATON PSYCHOLOGY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAXIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-336-3807
Mailing Address - Street 1:950 PENINSULA CORPORATE CIR STE 3000
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1387
Mailing Address - Country:US
Mailing Address - Phone:561-999-8881
Mailing Address - Fax:561-999-8884
Practice Address - Street 1:950 PENINSULA CORPORATE CIRCLE
Practice Address - Street 2:SUITE 3000
Practice Address - City:BOCA RATON,
Practice Address - State:FL
Practice Address - Zip Code:33487-1387
Practice Address - Country:US
Practice Address - Phone:561-999-8881
Practice Address - Fax:561-999-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)