| Paul Modesto, Ph.d.,p.a. | |
|
5301 N Federal Hwy Boca Raton FL 33487-4917 | |
| (561) 421-6628 | |
| (561) 241-8651 |
| Full Name | Paul Modesto, Ph.d.,p.a. |
|---|---|
| Speciality | Psychologist |
| Location | 5301 N Federal Hwy, Boca Raton, Florida |
| Authorized Official Name and Position | Paul Modesto (PSYCHOLOGIST) |
| Authorized Official Contact | 5612416628 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Paul Modesto, Ph.d.,p.a. 5301 N Federal Hwy Boca Raton FL 33487-4910 Ph: (561) 421-6628 | Paul Modesto, Ph.d.,p.a. 5301 N Federal Hwy Boca Raton FL 33487-4917 Ph: (561) 421-6628 |
| NPI Number | 1780683409 |
|---|---|
| Provider Enumeration Date | 07/15/2005 |
| Last Update Date | 10/06/2011 |
| Medicare PECOS PAC ID | 8426221763 |
|---|---|
| Medicare Enrollment ID | O20111101000382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780683409 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY2368 (Florida) | Primary |
| Provider Name | Paul Modesto |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629113568 PECOS PAC ID: 4183897432 Enrollment ID: I20111101000493 |
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