Provider Demographics
NPI:1356516090
Name:MINDWORKS INT INC
Entity type:Organization
Organization Name:MINDWORKS INT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR MINDWORKS INT IN
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRUCATO
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:305-232-6463
Mailing Address - Street 1:15321 S DIXIE HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1814
Mailing Address - Country:US
Mailing Address - Phone:305-232-6463
Mailing Address - Fax:305-232-4465
Practice Address - Street 1:15321 S DIXIE HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1814
Practice Address - Country:US
Practice Address - Phone:305-232-6463
Practice Address - Fax:305-232-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
73630OtherBC BS