Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY8220 | FL |
Y | 103TC0700X | Clinical Psychologist | PY8220 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY8220 | FL |
N | 103TF0000X | Family Psychologist | PY8220 | FL |
N | 103TP2701X | Group Psychotherapist | PY8220 | FL |
NPI | 1144454323 |
---|---|
Provider Name | Dr. Eric Y Reznik |
First Address | Hollywood, FL 33019-4810 |
Second Address | Hallandale Beach, FL 33009-4230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2009 |
Last Update Date | 14/12/2012 |