Provider Demographics
NPI:1801327564
Name:GRANADOS-RADLICK, PAOLA (PSYD)
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:
Last Name:GRANADOS-RADLICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BRICKELL AVE STE 850
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3212
Mailing Address - Country:US
Mailing Address - Phone:786-318-1915
Mailing Address - Fax:
Practice Address - Street 1:1200 BRICKELL AVE STE 850
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3212
Practice Address - Country:US
Practice Address - Phone:786-318-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9808103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent