Provider Demographics
NPI:1750168258
Name:RESILIENCE AND COGNITIVE BEHAVIOR THERAPY CENTER
Entity type:Organization
Organization Name:RESILIENCE AND COGNITIVE BEHAVIOR THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:MACHUCA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:504-388-5981
Mailing Address - Street 1:7601 E TREASURE DR APT 2117
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4369
Mailing Address - Country:US
Mailing Address - Phone:504-388-5981
Mailing Address - Fax:
Practice Address - Street 1:11300 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33161-6628
Practice Address - Country:US
Practice Address - Phone:504-388-5981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty