Provider Demographics
NPI:1598323651
Name:MIAMI INTEGRATED PSYCHOLOGY
Entity Type:Organization
Organization Name:MIAMI INTEGRATED PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IVELISSE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BARREIRO ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-902-4480
Mailing Address - Street 1:1001 BRICKELL BAY DR STE 2727
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-4900
Mailing Address - Country:US
Mailing Address - Phone:305-902-4480
Mailing Address - Fax:
Practice Address - Street 1:1001 BRICKELL BAY DR STE 2727
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-4900
Practice Address - Country:US
Practice Address - Phone:305-902-4480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health