Provider Demographics
NPI:1184823908
Name:PSYCHAWARENESS, INC.
Entity Type:Organization
Organization Name:PSYCHAWARENESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WENZE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:305-655-1108
Mailing Address - Street 1:633 NE 167TH ST STE 522
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2443
Mailing Address - Country:US
Mailing Address - Phone:305-655-1108
Mailing Address - Fax:305-655-1139
Practice Address - Street 1:633 NE 167TH ST STE 522
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2443
Practice Address - Country:US
Practice Address - Phone:305-655-1108
Practice Address - Fax:305-655-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7527251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health