Provider Demographics
NPI:1942842968
Name:CREATIVE KIDS THERAPY INC
Entity Type:Organization
Organization Name:CREATIVE KIDS THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-432-5099
Mailing Address - Street 1:5901 NW 151ST ST STE 124
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2454
Mailing Address - Country:US
Mailing Address - Phone:786-432-5099
Mailing Address - Fax:786-432-5100
Practice Address - Street 1:5881 NW 151ST ST STE 126
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2442
Practice Address - Country:US
Practice Address - Phone:786-432-5099
Practice Address - Fax:786-432-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104541800Medicaid