Provider Demographics
NPI:1306055942
Name:PALMWOOD CENTER FOR PSYCHOLOGICAL SERVICES, P.A.
Entity type:Organization
Organization Name:PALMWOOD CENTER FOR PSYCHOLOGICAL SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEC
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-742-7032
Mailing Address - Street 1:8890 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7235
Mailing Address - Country:US
Mailing Address - Phone:954-742-7032
Mailing Address - Fax:954-742-7868
Practice Address - Street 1:8890 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE #103
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7235
Practice Address - Country:US
Practice Address - Phone:954-742-7032
Practice Address - Fax:954-742-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004153103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59374Medicare ID - Type UnspecifiedALEC ROTH, PH.D.
FL73437Medicare ID - Type UnspecifiedMARLENE GRAY, PSY.D.