Provider Demographics
NPI:1083645865
Name:AMERICAN THERAPEUTIC CORPORATION
Entity Type:Organization
Organization Name:AMERICAN THERAPEUTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALERA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:305-371-5777
Mailing Address - Street 1:1801 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1000
Mailing Address - Country:US
Mailing Address - Phone:305-371-5777
Mailing Address - Fax:305-371-6007
Practice Address - Street 1:1001 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3148
Practice Address - Country:US
Practice Address - Phone:954-938-0919
Practice Address - Fax:954-938-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3296261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101465Medicare ID - Type Unspecified