Provider Demographics
NPI:1184403453
Name:SO BE MIND-BODY PA
Entity type:Organization
Organization Name:SO BE MIND-BODY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STONBELY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LCSW
Authorized Official - Phone:305-490-1738
Mailing Address - Street 1:1901 BRICKELL AVE APT B1214
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-1757
Mailing Address - Country:US
Mailing Address - Phone:305-490-1738
Mailing Address - Fax:
Practice Address - Street 1:1901 BRICKELL AVE APT B1214
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-1757
Practice Address - Country:US
Practice Address - Phone:305-490-1738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1851439921OtherNPI