Provider Demographics
NPI:1083146153
Name:THE PLAYFUL MINDS PSYCHOLOGY CENTER OF SOUTH FLORI
Entity Type:Organization
Organization Name:THE PLAYFUL MINDS PSYCHOLOGY CENTER OF SOUTH FLORI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTIOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL RIO-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-342-6130
Mailing Address - Street 1:2250 NW 136 AVE
Mailing Address - Street 2:SUITE 100C
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2586
Mailing Address - Country:US
Mailing Address - Phone:954-342-6130
Mailing Address - Fax:
Practice Address - Street 1:2250 NW 136 AVE
Practice Address - Street 2:SUITE 100C
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2586
Practice Address - Country:US
Practice Address - Phone:954-342-6130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7856103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty