Provider Demographics
NPI:1578996534
Name:CRYSTAL ACADEMY
Entity Type:Organization
Organization Name:CRYSTAL ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:MARGARITA
Authorized Official - Last Name:MONTERROSO
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:786-704-1485
Mailing Address - Street 1:110 PHOENETIA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3312
Mailing Address - Country:US
Mailing Address - Phone:305-567-5881
Mailing Address - Fax:
Practice Address - Street 1:110 PHOENETIA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3312
Practice Address - Country:US
Practice Address - Phone:305-567-5881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty