Provider Demographics
NPI:1710344593
Name:THERAPEUTIC INNOVATIVE PASSAGES SOLUTIONS
Entity Type:Organization
Organization Name:THERAPEUTIC INNOVATIVE PASSAGES SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-338-2363
Mailing Address - Street 1:2030 S OCEAN DR
Mailing Address - Street 2:1911
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6649
Mailing Address - Country:US
Mailing Address - Phone:305-338-2363
Mailing Address - Fax:
Practice Address - Street 1:2999 NE 191ST ST
Practice Address - Street 2:703
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3123
Practice Address - Country:US
Practice Address - Phone:305-931-5151
Practice Address - Fax:305-405-6171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW1114251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health