NPIMap

Organization Active NPI

Spanish River Church

  • Clinical Psychologist
  • Boca Raton, FL
National Provider Identifier
1699033381
Registry record updated May 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY6752 Issued in FL
Legal business name
SPANISH RIVER CHURCH
Practice address
2400 Yamato Rd
Boca Raton, FL 33431-8403
Phone
(561) 241-9014
Fax
(561) 994-2263
NPI assigned
May 1, 2012
Organization subpart
Yes
Parent organization
SPANISH RIVER CHURCHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 1, 2012

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

Authorized official

Name
Dr. Brent Gray, PH.D.NPI 1093017048
Title
Clinical Director
Phone
(561) 241-9014

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PY6752 FL Primary

Addresses

Primary practice location

2400 Yamato Rd
Boca Raton, FL 33431-8403

Mailing address

2400 Yamato Rd
Boca Raton, FL 33431-8403
Phone (561) 241-9014

Other names 1

  • Spanish River Counseling Center Other name

National Provider Directory

National Provider Directory
Part of
Spanish River Church

Locations

2400 W Yamato Rd
Boca Raton, FL 33431
Phone (561) 241-9014

Practitioners & affiliated clinicians

Practitioners 7

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": "1335830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335830400000",
    "number": "1699033381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 YAMATO RD",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334318403",
            "telephone_number": "561-241-9014",
            "fax_number": "561-994-2263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 YAMATO RD",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334318403",
            "telephone_number": "561-241-9014",
            "fax_number": "561-994-2263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPANISH RIVER CHURCH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPANISH RIVER CHURCH",
        "enumeration_date": "2012-05-01",
        "last_updated": "2012-05-01",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "561-241-9014",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY6752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spanish River Counseling Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Boca Raton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; 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.