Provider Demographics
NPI:1679710263
Name:MIAMI PSYCHCENTER LLC
Entity Type:Organization
Organization Name:MIAMI PSYCHCENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-446-0333
Mailing Address - Street 1:1390 S DIXIE HWY
Mailing Address - Street 2:STE 2219
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2927
Mailing Address - Country:US
Mailing Address - Phone:305-446-0333
Mailing Address - Fax:305-446-0333
Practice Address - Street 1:1390 S DIXIE HWY
Practice Address - Street 2:STE 2219
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2927
Practice Address - Country:US
Practice Address - Phone:305-446-0333
Practice Address - Fax:305-461-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2510106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty