Provider Demographics
NPI:1780931659
Name:DEVEREUX
Entity type:Organization
Organization Name:DEVEREUX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LEAD THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:DE LA HOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:305-796-7194
Mailing Address - Street 1:3155 N 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1347
Mailing Address - Country:US
Mailing Address - Phone:305-318-0091
Mailing Address - Fax:
Practice Address - Street 1:6365 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5952
Practice Address - Country:US
Practice Address - Phone:305-796-7194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency