Provider Demographics
NPI:1114129434
Name:SOUTH FLORIDA PSYCHOLOGICAL CENTER, INC.
Entity Type:Organization
Organization Name:SOUTH FLORIDA PSYCHOLOGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-822-6772
Mailing Address - Street 1:3408 W 84TH ST STE 317
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4944
Mailing Address - Country:US
Mailing Address - Phone:305-822-6772
Mailing Address - Fax:305-822-6245
Practice Address - Street 1:3408 W 84TH ST STE 317
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018
Practice Address - Country:US
Practice Address - Phone:305-822-6772
Practice Address - Fax:305-822-6245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1154488211OtherINDIVIDUAL PROVIDER