1326057704 NPI number — CENTER FOR PSYCHOTHERAPEUTIC SERVICES INC

Table of content: MRS. SARAH JORDAN LAKE ESKIN (NPI 1417219593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326057704 NPI number — CENTER FOR PSYCHOTHERAPEUTIC SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR PSYCHOTHERAPEUTIC SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326057704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1440 CORAL RIDGE DR
Provider Second Line Business Mailing Address:
SUITE 288
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33071-5433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-345-3898
Provider Business Mailing Address Fax Number:
954-227-8037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1440 CORAL RIDGE DR
Provider Second Line Business Practice Location Address:
SUITE 288
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33071-5433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-345-3898
Provider Business Practice Location Address Fax Number:
954-227-8037
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDSTEIN
Authorized Official First Name:
SHEPPARD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
954-345-3898

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW5849 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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