| Glenn R Caddy Phd Pa | |
|
3101 N Federal Hwy Suite 301 Ft Lauderdale FL 33306-1018 | |
| (954) 565-8850 | |
| Not Available |
| Full Name | Glenn R Caddy Phd Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 3101 N Federal Hwy, Ft Lauderdale, Florida |
| Authorized Official Name and Position | Glenn Ross Caddy (OWNER) |
| Authorized Official Contact | 9545658850 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glenn R Caddy Phd Pa 3101 N Federal Hwy Suite 301 Ft Lauderdale FL 33306-1018 Ph: (954) 565-8850 | Glenn R Caddy Phd Pa 3101 N Federal Hwy Suite 301 Ft Lauderdale FL 33306-1018 Ph: (954) 565-8850 |
| NPI Number | 1871755579 |
|---|---|
| Provider Enumeration Date | 06/25/2008 |
| Last Update Date | 12/02/2008 |
| Medicare PECOS PAC ID | 8729140678 |
|---|---|
| Medicare Enrollment ID | O20081231000115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871755579 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | PY2093 (Florida) | Primary |
| Provider Name | Glenn R Caddy |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497926687 PECOS PAC ID: 4183786031 Enrollment ID: I20081231000106 |
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