Provider Demographics
NPI:1578108403
Name:DESIGUAL THERAPY SERVICES INC
Entity Type:Organization
Organization Name:DESIGUAL THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:INDIRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MCSW, ICSW, CBHCMS
Authorized Official - Phone:786-612-4461
Mailing Address - Street 1:717 PONCE DE LEON BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2070
Mailing Address - Country:US
Mailing Address - Phone:305-952-3247
Mailing Address - Fax:305-952-3248
Practice Address - Street 1:717 PONCE DE LEON BLVD STE 307
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2070
Practice Address - Country:US
Practice Address - Phone:305-952-3247
Practice Address - Fax:305-952-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251B00000XAgenciesCase Management
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106429700Medicaid
FL104809400Medicaid
FL115630300Medicaid