Provider Demographics
NPI:1407837743
Name:INSTITUTE FOR FAMILY THERAPY INC
Entity Type:Organization
Organization Name:INSTITUTE FOR FAMILY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRTENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:305-558-7400
Mailing Address - Street 1:6175 NW 153RD ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2435
Mailing Address - Country:US
Mailing Address - Phone:305-558-7400
Mailing Address - Fax:305-558-6134
Practice Address - Street 1:6175 NW 153RD ST
Practice Address - Street 2:SUITE 404
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2435
Practice Address - Country:US
Practice Address - Phone:305-558-7400
Practice Address - Fax:305-558-6134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW16771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2506AMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER