| Memorial Division Of Child/adolescent Psychiatry | |
|
3440 Hollywood Blvd Ste 360 Hollywood FL 33021-6934 | |
| (954) 276-9200 | |
| (954) 275-0733 |
| Full Name | Memorial Division Of Child/adolescent Psychiatry |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3440 Hollywood Blvd Ste 360, Hollywood, Florida |
| Authorized Official Name and Position | Esther Surujon (CFO MPG, MPC AND UCC) |
| 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 Child/adolescent Psychiatry 2900 Corporate Way Mpg Door D Miramar FL 33025-3925 Ph: (954) 276-3254 | Memorial Division Of Child/adolescent Psychiatry 3440 Hollywood Blvd Ste 360 Hollywood FL 33021-6934 Ph: (954) 276-9200 |
| NPI Number | 1336504075 |
|---|---|
| Provider Enumeration Date | 12/23/2015 |
| Last Update Date | 07/12/2023 |
| Certification Date | 07/12/2023 |
| Medicare PECOS PAC ID | 8123927373 |
|---|---|
| Medicare Enrollment ID | O20160525000574 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336504075 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Silvia Fernandez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740447358 PECOS PAC ID: 4486726445 Enrollment ID: I20111101000325 |
| Provider Name | David M Rube |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083740484 PECOS PAC ID: 3577852912 Enrollment ID: I20160525000686 |
| Provider Name | Celine A Hamilton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801000971 PECOS PAC ID: 9537345236 Enrollment ID: I20190225001843 |
| Provider Name | Brian G Leduc |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346565736 PECOS PAC ID: 2567696016 Enrollment ID: I20220104001538 |
| Provider Name | Maria Atkinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477193951 PECOS PAC ID: 7012378755 Enrollment ID: I20230727004140 |
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