Provider Demographics
NPI:1629831334
Name:SISI THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:SISI THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILEM
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:305-986-9774
Mailing Address - Street 1:13944 SW 156TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6063
Mailing Address - Country:US
Mailing Address - Phone:305-986-9774
Mailing Address - Fax:
Practice Address - Street 1:13944 SW 156TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-6063
Practice Address - Country:US
Practice Address - Phone:305-986-9774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency