Provider Demographics
NPI:1770886517
Name:SADDLER, MIRICAL P
Entity type:Individual
Prefix:MISS
First Name:MIRICAL
Middle Name:P
Last Name:SADDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19370 COLLINS AVE
Mailing Address - Street 2:SUITE#411
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2240
Mailing Address - Country:US
Mailing Address - Phone:305-467-4531
Mailing Address - Fax:
Practice Address - Street 1:19370 COLLINS AVE
Practice Address - Street 2:SUITE #411
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2240
Practice Address - Country:US
Practice Address - Phone:305-467-4531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10496101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health