Provider Demographics
NPI:1477983286
Name:PSYCHOLOGICAL SERVICES OF MIAMI CORP
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES OF MIAMI CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUMAN
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:JERANI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:786-351-6396
Mailing Address - Street 1:10710 NW 66 STREET APT 502
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33178
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 NW 4TH ST
Practice Address - Street 2:CLINICIAN'S OFFICE ON FIRST FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-1668
Practice Address - Country:US
Practice Address - Phone:786-351-6396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health