Provider Demographics
NPI:1134622335
Name:T E A MIAMI, INC
Entity type:Organization
Organization Name:T E A MIAMI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYSELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSOPENATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-554-1676
Mailing Address - Street 1:8233 HARDING AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-5214
Mailing Address - Country:US
Mailing Address - Phone:786-296-7024
Mailing Address - Fax:
Practice Address - Street 1:8233 HARDING AVE APT 302
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-5214
Practice Address - Country:US
Practice Address - Phone:786-296-7024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-17-25353103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty