Provider Demographics
NPI:1598712234
Name:CENTER FOR SELF-DEVELOPMENT CORP
Entity Type:Organization
Organization Name:CENTER FOR SELF-DEVELOPMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:MV
Authorized Official - Last Name:BUKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-749-2500
Mailing Address - Street 1:21205 YACHT CLUB DR
Mailing Address - Street 2:# 3201
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180
Mailing Address - Country:US
Mailing Address - Phone:305-749-2500
Mailing Address - Fax:305-749-2505
Practice Address - Street 1:18851 NE 29TH AV
Practice Address - Street 2:SUITE 700
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-4049
Practice Address - Country:US
Practice Address - Phone:305-749-2500
Practice Address - Fax:305-749-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME602402084P0800X
NY1851632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E76757Medicare UPIN
12902Medicare ID - Type UnspecifiedINDIVIDUAL