Provider Demographics
NPI:1366988610
Name:BEACH CITIES PSYCHOLOGICAL CLINIC, INC.
Entity type:Organization
Organization Name:BEACH CITIES PSYCHOLOGICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:949-813-8180
Mailing Address - Street 1:13555 SE 93RD COURT RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-9459
Mailing Address - Country:US
Mailing Address - Phone:949-813-8180
Mailing Address - Fax:
Practice Address - Street 1:13555 SE 93RD COURT RD
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-9459
Practice Address - Country:US
Practice Address - Phone:949-813-8180
Practice Address - Fax:224-365-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25548103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty