Provider Demographics
NPI:1366683310
Name:THERAPEUTIC BEHAVIORAL ASSESSMENT
Entity Type:Organization
Organization Name:THERAPEUTIC BEHAVIORAL ASSESSMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMUS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-274-0640
Mailing Address - Street 1:8200 SW 117TH AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3856
Mailing Address - Country:US
Mailing Address - Phone:305-274-0640
Mailing Address - Fax:305-274-0630
Practice Address - Street 1:8200 SW 117TH AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3856
Practice Address - Country:US
Practice Address - Phone:305-274-0640
Practice Address - Fax:305-274-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7870251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004477900Medicaid
FL687253196Medicaid