Provider Demographics
NPI:1962730143
Name:ADULT & CHILDREN PSYCHOLOGICAL SERVICES INC
Entity type:Organization
Organization Name:ADULT & CHILDREN PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:E
Authorized Official - Last Name:POLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-826-9293
Mailing Address - Street 1:6450 W 21ST CT
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3946
Mailing Address - Country:US
Mailing Address - Phone:305-826-9293
Mailing Address - Fax:305-826-9224
Practice Address - Street 1:6450 W 21ST CT
Practice Address - Street 2:SUITE # 207
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-3946
Practice Address - Country:US
Practice Address - Phone:305-826-9293
Practice Address - Fax:305-826-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5253103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59737Medicare UPIN