Provider Demographics
NPI:1083349948
Name:DNA PEDIATRIC COUNSELING SERVICES & RESOURCES
Entity Type:Organization
Organization Name:DNA PEDIATRIC COUNSELING SERVICES & RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIEU
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:786-356-9394
Mailing Address - Street 1:2413 MAIN ST # 545
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7809
Mailing Address - Country:US
Mailing Address - Phone:305-707-0728
Mailing Address - Fax:
Practice Address - Street 1:9351 E HEATHER LN
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-2638
Practice Address - Country:US
Practice Address - Phone:786-356-9394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1295273779Medicaid