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A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or is demonstrably at high risk of impairment (1974).
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Health Service |
103TH0100X | 62 | Psychologist, Clinical |
| NPI # | 1083110019 |
| LBN Legal business name | COASTAL PEDIATRIC ASSOCIATES, P.A. |
| Authorized official | DANA WOLF - (DIRECTOR OF QUALITY PROGRAMS) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 03/30/2018 |
| Last updated | 03/30/2018 - About 8 years ago |
| Identifiers | n/a |
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COASTAL PEDIATRIC ASSOCIATES, P.A.