Provider Demographics
NPI:1013349786
Name:MARTHA BOFILL & ASSOCIATES PSY CORP
Entity Type:Organization
Organization Name:MARTHA BOFILL & ASSOCIATES PSY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOFILL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:786-587-2617
Mailing Address - Street 1:747 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2049
Mailing Address - Country:US
Mailing Address - Phone:786-587-2617
Mailing Address - Fax:305-454-0156
Practice Address - Street 1:747 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 501
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2049
Practice Address - Country:US
Practice Address - Phone:786-587-2617
Practice Address - Fax:305-454-0156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7089103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty