Provider Demographics
NPI:1437456688
Name:INNER REFLECTION THERAPY CENTER P.A.
Entity Type:Organization
Organization Name:INNER REFLECTION THERAPY CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:MARGARITA
Authorized Official - Last Name:IZQUIERDO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-318-5539
Mailing Address - Street 1:2125 BISCAYNE BOULEVARD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MAIMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137
Mailing Address - Country:US
Mailing Address - Phone:305-576-4279
Mailing Address - Fax:305-576-4861
Practice Address - Street 1:2125 BISCAYNE BOULEVARD
Practice Address - Street 2:SUITE 550
Practice Address - City:MAIMI
Practice Address - State:FL
Practice Address - Zip Code:33137
Practice Address - Country:US
Practice Address - Phone:305-576-4279
Practice Address - Fax:305-576-4861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 4833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty