NPIMap

Organization Active NPI

Psychological Affiliates, Inc.

  • Clinical Child & Adolescent Psychologist
  • Winter Park, FL
National Provider Identifier
1649324005
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
PY3963 Issued in FL
Legal business name
PSYCHOLOGICAL AFFILIATES, INC.
Practice address
2737 W Fairbanks Ave
Winter Park, FL 32789-3314
Phone
(407) 740-6838
Fax
(407) 740-0902
NPI assigned
Jan 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jean M Croughn
Title
Office Manager
Phone
(407) 740-6838

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC2200X PY3963 FL Primary

Addresses

Primary practice location

2737 W Fairbanks Ave
Winter Park, FL 32789-3314

Mailing address

2737 W Fairbanks Ave
Winter Park, FL 32789-3314
Phone (407) 740-6838

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649324005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2737 W FAIRBANKS AVE",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327893314",
            "telephone_number": "407-740-6838",
            "fax_number": "407-740-0902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2737 W FAIRBANKS AVE",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327893314",
            "telephone_number": "407-740-6838",
            "fax_number": "407-740-0902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL AFFILIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CROUGHN",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "407-740-6838",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "FL",
            "license": "PY3963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.