Provider Demographics
NPI:1467974741
Name:THE OLIVE TREE CENTER FOR CHILD AND FAMILY PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:THE OLIVE TREE CENTER FOR CHILD AND FAMILY PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLIVOS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-792-8168
Mailing Address - Street 1:8129 ABBOTT AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-1658
Mailing Address - Country:US
Mailing Address - Phone:305-792-8168
Mailing Address - Fax:305-675-0689
Practice Address - Street 1:975 ARTHUR GODFREY RD STE 303
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3342
Practice Address - Country:US
Practice Address - Phone:305-792-8168
Practice Address - Fax:305-675-0689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-09
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9816103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty