Provider Demographics
NPI:1598024325
Name:ADVANCED BEHAVIORAL NETWORK
Entity Type:Organization
Organization Name:ADVANCED BEHAVIORAL NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:PILAR
Authorized Official - Last Name:GONDRA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-648-0604
Mailing Address - Street 1:250 CATALONIA AVE
Mailing Address - Street 2:SUITE 807
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6735
Mailing Address - Country:US
Mailing Address - Phone:305-648-0604
Mailing Address - Fax:
Practice Address - Street 1:250 CATALONIA AVE
Practice Address - Street 2:SUITE 807
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6735
Practice Address - Country:US
Practice Address - Phone:305-648-0604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty