| Memorial Division Of Rehabilitative Psychology | |
|
3600 Washington St Ste 311 Hollywood FL 33021-8216 | |
| (954) 518-5507 | |
| (954) 518-5510 |
| Full Name | Memorial Division Of Rehabilitative Psychology |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 3600 Washington St Ste 311, Hollywood, Florida |
| Authorized Official Name and Position | Esther Surujon (CFO MEMORIAL PHYSICIAN GROUP & MPC) |
| Authorized Official Contact | 9542656677 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Memorial Division Of Rehabilitative Psychology 2900 Corporate Way Door D Miramar FL 33025-3925 Ph: (954) 265-5685 | Memorial Division Of Rehabilitative Psychology 3600 Washington St Ste 311 Hollywood FL 33021-8216 Ph: (954) 518-5507 |
| NPI Number | 1245656792 |
|---|---|
| Provider Enumeration Date | 03/07/2014 |
| Last Update Date | 06/20/2023 |
| Certification Date | 06/20/2023 |
| Medicare PECOS PAC ID | 8123927373 |
|---|---|
| Medicare Enrollment ID | O20140813000526 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245656792 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| Provider Name | Thomas A Crum |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811053739 PECOS PAC ID: 6901709401 Enrollment ID: I20110628000863 |
| Provider Name | Marian Rosado |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1023401932 PECOS PAC ID: 1153649678 Enrollment ID: I20150414000947 |
| Provider Name | Karinna O Vazquez |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1477039451 PECOS PAC ID: 3971840844 Enrollment ID: I20190130002583 |
| Provider Name | Christina J Ortega |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376950022 PECOS PAC ID: 4486934791 Enrollment ID: I20200212000105 |
| Provider Name | Karin A Cabeza |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578102497 PECOS PAC ID: 9133556988 Enrollment ID: I20200217004692 |
| Provider Name | Selin Santos |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285163543 PECOS PAC ID: 0941638480 Enrollment ID: I20200317001536 |
| Provider Name | Evelyn Ramirez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649986175 PECOS PAC ID: 8123478500 Enrollment ID: I20231227002367 |
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