Provider Demographics
NPI:1497904221
Name:MIRTA RICE PSYD LLC
Entity Type:Organization
Organization Name:MIRTA RICE PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRTA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-385-0353
Mailing Address - Street 1:1625 N COMMERCE PKWY
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3216
Mailing Address - Country:US
Mailing Address - Phone:954-385-0353
Mailing Address - Fax:954-389-0886
Practice Address - Street 1:1625 N COMMERCE PKWY
Practice Address - Street 2:SUITE NUMBER 200
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3216
Practice Address - Country:US
Practice Address - Phone:954-385-0353
Practice Address - Fax:954-389-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103TA0700X, 103TC2200X
103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty