Provider Demographics
NPI:1285893180
Name:COMMUNITY PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:COMMUNITY PSYCHOLOGICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:PAWLILLO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-727-9956
Mailing Address - Street 1:150 W UNIVERSITY BLVD
Mailing Address - Street 2:BUILDING 265
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-6975
Mailing Address - Country:US
Mailing Address - Phone:321-727-9956
Mailing Address - Fax:321-726-6727
Practice Address - Street 1:150 W UNIVERSITY BLVD
Practice Address - Street 2:BUILDING 265
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-6975
Practice Address - Country:US
Practice Address - Phone:321-727-9956
Practice Address - Fax:321-726-6727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA INSTITUTE OF TECHNOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP43748251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health