Provider Demographics
NPI:1679693121
Name:CARY R SHOOKOFF PHD PSYCHOLOGIST LLC
Entity type:Organization
Organization Name:CARY R SHOOKOFF PHD PSYCHOLOGIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PRESIDENT PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHOOKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-674-0055
Mailing Address - Street 1:1900 PURDY AVE STE 2
Mailing Address - Street 2:COMM. UNITS G & G
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1409
Mailing Address - Country:US
Mailing Address - Phone:305-674-0055
Mailing Address - Fax:305-341-3935
Practice Address - Street 1:1900 PURDY AVE STE 2
Practice Address - Street 2:COMM. UNITS G & G
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-1409
Practice Address - Country:US
Practice Address - Phone:305-674-0055
Practice Address - Fax:305-341-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 2924103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59 2398787OtherFEDERAL TAX ID
FL73236OtherBLUE CROSS - MEDICARE