Provider Demographics
NPI:1164805305
Name:FLORIDA INTERNATIONAL UNIVERSITY BOARD OF TRUSTEES CENTER FOR CHILDREN
Entity Type:Organization
Organization Name:FLORIDA INTERNATIONAL UNIVERSITY BOARD OF TRUSTEES CENTER FOR CHILDREN
Other - Org Name:FIU CENTER FOR CHILDREN AND FAMILIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PELHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-348-3002
Mailing Address - Street 1:11200 SW 8TH ST
Mailing Address - Street 2:AHC 1 ROOM 140
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33199-2516
Mailing Address - Country:US
Mailing Address - Phone:305-348-0477
Mailing Address - Fax:305-348-3646
Practice Address - Street 1:11200 SW 8TH ST
Practice Address - Street 2:AHC 1 ROOM 140
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33199-2516
Practice Address - Country:US
Practice Address - Phone:305-348-0477
Practice Address - Fax:305-348-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty