Provider Demographics
NPI:1558648592
Name:SOUTH MIAMI PSYCHOLOGY GROUP
Entity Type:Organization
Organization Name:SOUTH MIAMI PSYCHOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-662-2686
Mailing Address - Street 1:1390 SOUTH DIXIE HIGHWAY
Mailing Address - Street 2:#1109
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146
Mailing Address - Country:US
Mailing Address - Phone:305-662-2686
Mailing Address - Fax:305-631-2152
Practice Address - Street 1:1390 SOUTH DIXIE HIGHWAY
Practice Address - Street 2:#1109
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146
Practice Address - Country:US
Practice Address - Phone:305-662-2686
Practice Address - Fax:305-631-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty