| Clag Psychological Center & Consultants, Llc | |
|
12260 Glenmore Dr Coral Springs FL 33071-7878 | |
| (787) 593-7082 | |
| Not Available |
| Full Name | Clag Psychological Center & Consultants, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 12260 Glenmore Dr, Coral Springs, Florida |
| Authorized Official Name and Position | Vimary Rodriguez (CEO) |
| Authorized Official Contact | 7875937082 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clag Psychological Center & Consultants, Llc 12260 Glenmore Dr Coral Springs FL 33071-7878 Ph: (787) 593-7082 | Clag Psychological Center & Consultants, Llc 12260 Glenmore Dr Coral Springs FL 33071-7878 Ph: (787) 593-7082 |
| NPI Number | 1811641715 |
|---|---|
| Provider Enumeration Date | 02/09/2022 |
| Last Update Date | 02/09/2022 |
| Certification Date | 02/09/2022 |
| Medicare PECOS PAC ID | 9739567603 |
|---|---|
| Medicare Enrollment ID | O20220606000294 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811641715 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Vimary Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1144375338 PECOS PAC ID: 1456257443 Enrollment ID: I20180306001009 |
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