Provider Demographics
NPI:1962696955
Name:PRIMARY CARE PSYCHOLOGY, PLC
Entity type:Organization
Organization Name:PRIMARY CARE PSYCHOLOGY, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISTIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-788-9399
Mailing Address - Street 1:1990 N FEDERAL HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-1032
Mailing Address - Country:US
Mailing Address - Phone:954-788-9399
Mailing Address - Fax:954-905-4990
Practice Address - Street 1:1990 N FEDERAL HWY
Practice Address - Street 2:SUITE C
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1032
Practice Address - Country:US
Practice Address - Phone:954-788-9399
Practice Address - Fax:954-905-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-01
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6322103TC0700X, 251S00000X, 261Q00000X, 261QH0100X, 261QM0801X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5792Medicare PIN
FLP35474Medicare UPIN