Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY9131 | FL |
Y | 103TC0700X | Clinical Psychologist | PY9131 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY9131 | FL |
NPI | 1104224211 |
---|---|
Provider Name | Dr. Edan M Alcalay |
First Address | Boca Raton, FL 33487-1388 |
Second Address | Boca Raton, FL 33487-1388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2014 |
Last Update Date | 01/07/2021 |