| Entity Name: | FORT LAUDERDALE PSYCHOLOGY PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Oct 2012 (12 years ago) |
| Last Event: | AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 16 Mar 2017 (8 years ago) |
| Document Number: | P12000085038 |
| FEI/EIN Number | 46-1177536 |
| Address: | 2601 East Oakland Park Blvd, 502, FORT LAUDERDALE, FL, 33306, US |
| Mail Address: | 2601 East Oakland Park Blvd, 502, FORT LAUDERDALE, FL, 33306, US |
| ZIP code: | 33306 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912438375 | 2017-03-27 | 2017-03-27 | 115 NE 3RD AVE, #305, FORT LAUDERDALE, FL, 333011291, US | 2755 E OAKLAND PARK BLVD, SUITE 225, FORT LAUDERDALE, FL, 333061637, US | |||||||||||||||||||||||||
|
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| Phone | +1 954-260-8790 |
Authorized person
| Name | DR. NICOLLE ANNE DELEO |
| Role | OWNER/PRESIDENT |
| Phone | 9542608790 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH:10032 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY: 8799 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| OBEIDY ANDREW Esq. | Agent | 2755 EAST OAKLAND PARK #225, FORT LAUDERDALE, FL, 33306 |
| Name | Role | Address |
|---|---|---|
| DeLeo Nicolle Dr. | President | 2601 East Oakland Park Blvd, FORT LAUDERDALE, FL, 33306 |
| Name | Role | Address |
|---|---|---|
| DeLeo Nicolle Dr. | Secretary | 2601 East Oakland Park Blvd, FORT LAUDERDALE, FL, 33306 |
| Name | Role | Address |
|---|---|---|
| DeLeo Nicolle Dr. | Treasurer | 2601 East Oakland Park Blvd, FORT LAUDERDALE, FL, 33306 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000020288 | HEARTLAND PSYCHOLOGY | ACTIVE | 2023-02-12 | 2028-12-31 | No data | 34 W. SIDE SQUARE, 315, MACOMB, IL, 61455 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-12 | 2601 East Oakland Park Blvd, 502, FORT LAUDERDALE, FL 33306 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-12 | 2601 East Oakland Park Blvd, 502, FORT LAUDERDALE, FL 33306 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-06 | 2755 EAST OAKLAND PARK #225, FORT LAUDERDALE, FL 33306 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-06-18 | OBEIDY, ANDREW, Esq. | No data |
| AMENDMENT AND NAME CHANGE | 2017-03-16 | FORT LAUDERDALE PSYCHOLOGY PA | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-12 |
| ANNUAL REPORT | 2023-02-06 |
| ANNUAL REPORT | 2022-03-23 |
| ANNUAL REPORT | 2021-02-03 |
| AMENDED ANNUAL REPORT | 2020-06-18 |
| ANNUAL REPORT | 2020-04-03 |
| ANNUAL REPORT | 2019-04-06 |
| ANNUAL REPORT | 2018-03-24 |
| ANNUAL REPORT | 2017-04-12 |
| Amendment and Name Change | 2017-03-16 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
